MEDICARE: LAPORTE FAMILY VISION INC

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	152W00000X	Optometrist	18002633 A & B	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	247510	OTHER	IN	PTAN

General Provider Information

NPI Number	:	1356447007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAPORTE FAMILY VISION INC

Provider Business Mailing Address
First Line	:	1231 N STATE ROAD 39
Second Line	:
City	:	LA PORTE
State	:	IN
Zip	:	46350-2042
Country	:	US
Telephone Number	:	219-326-7681
Fax Number	:

Provider Business Practice Location Address
First Line	:	1231 N STATE ROAD 39
Second Line	:
City	:	LA PORTE
State	:	IN
Zip	:	46350-2042
Country	:	US
Telephone Number	:	219-326-7681
Fax Number	:

Authorized Official
Title or Position	:	OWNER & PRESIDENT
Name	:	DR. PAMELA J HEYNE-THOMPSON
Credential	:	O.D.
Telephone Number	:	219-326-7681

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	12/17/2008

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Directions to “LAPORTE FAMILY VISION INC ” Practice Location

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