Healthcare Provider Details

I. General information

NPI: 1790176394
Provider Name (Legal Business Name): OSSIP OPTOMETRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14540 PRAIRIE LAKES BLVD N STE 100
NOBLESVILLE IN
46060-4366
US

IV. Provider business mailing address

9795 CROSSPOINT BLVD STE 100
INDIANAPOLIS IN
46256-3354
US

V. Phone/Fax

Practice location:
  • Phone: 317-770-8555
  • Fax: 317-770-8558
Mailing address:
  • Phone: 317-254-6480
  • Fax: 317-259-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number01048750
License Number StateIN

VIII. Authorized Official

Name: RYAN DABELOW
Title or Position: DIRECTOR OF FINANCE AND INSURANCE
Credential:
Phone: 317-254-6480