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General NPI Number Information
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NPI Number | 1255478491
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Entity Type | Organization
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Legal Business Name | INDIANA VISION IMPROVEMENT CENTER
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 04/09/2008
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Provider Practice Location Address
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Address Line | 1250 E COUNTY LINE RD SUITE4
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-1004
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Country | US
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Telephone | 317-882-1527
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Fax | 317-882-4092
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Provider Business Mailing Address
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Address Line | 1250 E COUNTY LINE RD SUITE4
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-1004
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Country | US
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Telephone | 317-882-1527
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Fax | 317-882-4092
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SUZANNE K ROBERTS
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Credential |
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Telephone | 317-882-1527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State | IN
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