Healthcare Provider Details

I. General information

NPI: 1225621071
Provider Name (Legal Business Name): LOOGOOTEE EYE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 03/16/2025
Certification Date: 03/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W MAIN ST
LOOGOOTEE IN
47553-1506
US

IV. Provider business mailing address

403 WALKER ST
LOOGOOTEE IN
47553-1424
US

V. Phone/Fax

Practice location:
  • Phone: 812-295-3163
  • Fax: 812-901-6627
Mailing address:
  • Phone: 260-415-0267
  • Fax: 260-673-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL ALVAREZ
Title or Position: PRESIDENT
Credential: OD
Phone: 260-415-0267