MEDICARE: CORESIGHT NEURO-OPHTHALMOLOGY LLC

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	261QM2500X	Medical Specialty Clinic/Center	01070571A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467813204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORESIGHT NEURO-OPHTHALMOLOGY LLC

Provider Business Mailing Address
First Line	:	PO BOX 281
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46082-0281
Country	:	US
Telephone Number	:	317-663-9518
Fax Number	:

Provider Business Practice Location Address
First Line	:	13400 N MERIDIAN ST
Second Line	:	SUITE 283
City	:	CARMEL
State	:	IN
Zip	:	46032-7102
Country	:	US
Telephone Number	:	317-663-9518
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. MAYSA ALI RIDHA
Credential	:	MD
Telephone Number	:	317-663-9518

Provider Enumeration Date	:	03/07/2016
Last Update Date	:	01/12/2024

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