=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992027791
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEEN MCQUITTY P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2010
-----------------------------------------------------
Last Update Date | 12/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12114 SIGILLARY WAY
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46032-6328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-840-9520
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12114 SIGILLARY WAY
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46032-6328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 131-784-0952
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | STEVEN CALVIN DEEN
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 317-840-9520
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------