MEDICARE: FORT WAYNE FAMILY EYECARE

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000234540	OTHER	IN	ANTHEM NONPAR
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396778882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORT WAYNE FAMILY EYECARE

Provider Business Mailing Address
First Line	:	1515 E PAULDING RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46816-1252
Country	:	US
Telephone Number	:	260-744-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 E PAULDING RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46816-1252
Country	:	US
Telephone Number	:	260-744-2273
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK A INGLE
Credential	:	O.D.
Telephone Number	:	260-744-2273

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	08/08/2008

Similar Medicare Providers

1477547628 — DR. BRADLEY S BASHAM O.D.
Practice Location Address:

1515 E PAULDING RD
FORT WAYNE, IN
46816-1252

Practice Phone: 260-744-2273
Practice Fax: 260-744-4555

1821283839 — MRS. ANDRIA KRISITIN SPRUIELL COTA
Practice Location Address:

1252 MOUNTAIN AIR TRL
FORT WORTH, TX
76131-5445

Practice Phone: 817-880-4972
Practice Fax:

1386975068 — MRS. MARY H STAUDTER MS, RD, LD
Practice Location Address:

126 MISSOURI AVE , BOX 1252
FORT LEONARD WOOD, MO
65473-8952

Practice Phone: 573-596-1762
Practice Fax:

1700180817 — MS. ALLISON FAYE SWEET RD
Practice Location Address:

126 MISSOURI AVE # 1252
FORT LEONARD WOOD, MO
65473-8952

Practice Phone: 573-596-0131
Practice Fax: 573-596-0496

1316331036 — DENESE SHARON ARVELO PSY.D.
Practice Location Address:

A.T. AUGUSTA MMC , 9300 DEWITT LOOP
FORT BELVOIR, VA
22060-1252

Practice Phone: 571-523-3224
Practice Fax:

1992231294 — PAUL PROMADHATTVEDI M.D.
Practice Location Address:

255 FORT WASHINGTON AVE APT 41
NEW YORK, NY
10032-1252

Practice Phone: 917-328-3232
Practice Fax:

Directions to “FORT WAYNE FAMILY EYECARE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.