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General NPI Number Information
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NPI Number | 1548966054
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Entity Type | Organization
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Legal Business Name | MAGNANTE EYE CARE II LLC
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Dates
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Enumeration Date | 02/06/2023
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 975 MEZZANINE DR STE B
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City | LAFAYETTE
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State | IN
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Zip | 47905-8635
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Country | US
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Telephone | 765-449-7564
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Fax | 765-807-7943
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Provider Business Mailing Address
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Address Line | 975 MEZZANINE DR STE B
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City | LAFAYETTE
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State | IN
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Zip | 47905-8635
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Country | US
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Telephone | 765-449-7564
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Fax | 765-807-7943
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Authorized Official
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Title or Position | MD
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Name | DAVID MAGNANTE
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Credential |
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Telephone | 765-449-7564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 |
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