Healthcare Provider Details

I. General information

NPI: 1801002522
Provider Name (Legal Business Name): MIDWEST EYE CONSULTANTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 W LINCOLN RD
KOKOMO IN
46902-3275
US

IV. Provider business mailing address

PO BOX 6550
KOKOMO IN
46904-6550
US

V. Phone/Fax

Practice location:
  • Phone: 765-453-5696
  • Fax: 765-455-4323
Mailing address:
  • Phone: 765-453-5696
  • Fax: 765-455-4323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number17001243A
License Number StateIN

VIII. Authorized Official

Name: GREGRORY L GARNER
Title or Position: PRES./CEO
Credential:
Phone: 260-569-9550