Healthcare Provider Details

I. General information

NPI: 1609621580
Provider Name (Legal Business Name): MIDWEST EYE CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 STOUT HERITAGE PKWY STE 100
PLAINFIELD IN
46168-5557
US

IV. Provider business mailing address

PO BOX 549
WABASH IN
46992-0549
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: CATHY GARRETT
Title or Position: COO
Credential:
Phone: 260-569-9550