Healthcare Provider Details

I. General information

NPI: 1245304476
Provider Name (Legal Business Name): ELITE OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8510 BROADWAY
MERRILLVILLE IN
46410
US

IV. Provider business mailing address

8510 BROADWAY
MERRILLVILLE IN
46410
US

V. Phone/Fax

Practice location:
  • Phone: 219-756-5020
  • Fax: 219-736-2222
Mailing address:
  • Phone: 219-756-5020
  • Fax: 219-736-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. ELDI E DESCHAMPS
Title or Position: PRESIDENT
Credential: MD
Phone: 219-736-2200