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General NPI Number Information
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NPI Number | 1578664181
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Entity Type | Organization
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Legal Business Name | MEDICAL ARTS OPTICAL
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1400 N RITTER AVE SUITE 270
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-3052
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Country | US
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Telephone | 317-353-9321
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Fax | 317-357-5383
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Provider Business Mailing Address
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Address Line | 1400 N RITTER AVE SUITE 270
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-3052
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Country | US
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Telephone | 317-353-9321
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Fax | 317-357-5383
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Authorized Official
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Title or Position | OPTICIAN
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Name | VICKI NEVINS
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Credential |
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Telephone | 317-353-9321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 31426
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License Number State | IN
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