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General NPI Number Information
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NPI Number | 1356065478
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Entity Type | Organization
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Legal Business Name | MIDWEST OPTOMETRY SERVICES LLC
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Dates
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Enumeration Date | 10/03/2022
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Last Update Date | 10/03/2022
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Provider Practice Location Address
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Address Line | 2852 E 3RD ST SPC L07
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City | BLOOMINGTON
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State | IN
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Zip | 47401-5423
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Country | US
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Telephone | 812-334-1872
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Fax |
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Provider Business Mailing Address
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Address Line | 2007 E GREYHOUND PASS STE 4
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City | CARMEL
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State | IN
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Zip | 46033-7753
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Country | US
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Telephone | 317-841-0712
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | CHRISTOPHER EMMONS
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Credential | OD
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Telephone | 317-841-0712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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