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General NPI Number Information
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NPI Number | 1548427065
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Entity Type | Organization
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Legal Business Name | EYECARE INDIANA
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 10/09/2014
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Provider Practice Location Address
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Address Line | 24 N EARL AVE
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City | LAFAYETTE
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State | IN
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Zip | 47904-2813
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Country | US
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Telephone | 765-447-0880
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Fax | 765-447-4789
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Provider Business Mailing Address
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Address Line | 9795 CROSSPOINT BLVD STE 100
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-3354
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Country | US
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Telephone | 317-254-6480
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Fax | 317-259-8609
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGG L OSSIP
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Credential | O.D.
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Telephone | 317-254-6480
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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 | 18003749
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003757
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License Number State | IN
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