Healthcare Provider Details

I. General information

NPI: 1740357748
Provider Name (Legal Business Name): EYE PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 W 2ND ST
PERU IN
46970-2159
US

IV. Provider business mailing address

3433 S LAFOUNTAIN ST
KOKOMO IN
46902-3801
US

V. Phone/Fax

Practice location:
  • Phone: 765-472-2000
  • Fax: 765-472-2923
Mailing address:
  • Phone: 765-453-3777
  • Fax: 765-453-6577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number50000605A
License Number StateIN

VIII. Authorized Official

Name: MICHAEL R WILD
Title or Position: OWNER
Credential: MD
Phone: 765-453-3777