MEDICARE: SURGERY CENTER OF EYE SPECIALISTS OF INDIANA, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1306260815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGERY CENTER OF EYE SPECIALISTS OF INDIANA, PC

Provider Business Mailing Address
First Line	:	1901 N MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1303
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 W 86TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-2076
Country	:	US
Telephone Number	:	317-925-2200
Fax Number	:

Authorized Official
Title or Position	:	CEO/ OWNER
Name	:	PAUL LOUIS WALTON
Credential	:
Telephone Number	:	317-925-2200

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	08/30/2021

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