Healthcare Provider Details

I. General information

NPI: 1194788711
Provider Name (Legal Business Name): MIDWEST EYE CONSULTANTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 STATE ROAD 114 E
NORTH MANCHESTER IN
46962-9393
US

IV. Provider business mailing address

PO BOX 549
WABASH IN
46992-0549
US

V. Phone/Fax

Practice location:
  • Phone: 260-982-8681
  • Fax: 260-982-2912
Mailing address:
  • Phone: 260-569-9550
  • Fax: 260-569-0760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number56000164A
License Number StateIN

VIII. Authorized Official

Name: GREGORY L GARNER
Title or Position: PRES./CEO
Credential:
Phone: 260-569-9550