Healthcare Provider Details

I. General information

NPI: 1902154842
Provider Name (Legal Business Name): INDIANA UNIVERSITY EYE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 N LEBANON ST SUITE 230
LEBANON IN
46052-8621
US

IV. Provider business mailing address

1160 W MICHIGAN ST
INDIANAPOLIS IN
46202-5209
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-2020
  • Fax: 317-274-3265
Mailing address:
  • Phone: 317-274-2020
  • Fax: 317-274-3265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003053
License Number StateIN

VIII. Authorized Official

Name: DR. LOUIS B CANTOR
Title or Position: CHAIRMAN
Credential: M.D.
Phone: 317-278-2651