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General NPI Number Information
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NPI Number | 1275081788
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Entity Type | Organization
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Legal Business Name | LA PORTE CLINIC COMPANY LLC
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Dates
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Enumeration Date | 09/13/2016
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 1300 STATE ST SUITE 1B
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City | LA PORTE
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State | IN
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Zip | 46350-3185
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Country | US
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Telephone | 219-362-6297
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Fax | 219-324-3061
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Provider Business Mailing Address
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Address Line | PO BOX 689022
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City | FRANKLIN
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State | TN
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Zip | 37068-9022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MICHAEL A SWAW
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Credential |
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Telephone | 615-778-8076
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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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Taxonomy #2
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number |
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | IN
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