Healthcare Provider Details

I. General information

NPI: 1306928064
Provider Name (Legal Business Name): OPHTHALMOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 STATE ST STE. 1-F
LA PORTE IN
46350-3185
US

IV. Provider business mailing address

1300 STATE ST STE. 1F
LA PORTE IN
46350-3185
US

V. Phone/Fax

Practice location:
  • Phone: 219-362-6297
  • Fax: 219-324-3061
Mailing address:
  • Phone: 219-362-6297
  • Fax: 219-324-3061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN C MANNIX
Title or Position: PRESIDENT OWNER
Credential: M.D.
Phone: 219-362-6297