MEDICARE: UNIVERSITY EYE INSTITUTE 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	152W00000X	Optometrist	18003569A	IN
2	152W00000X	Optometrist

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558596247
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY EYE INSTITUTE PC

Provider Business Mailing Address
First Line	:	2720 169TH ST
Second Line	:
City	:	HAMMOND
State	:	IN
Zip	:	46323-1508
Country	:	US
Telephone Number	:	219-845-2020
Fax Number	:	219-845-2012

Provider Business Practice Location Address
First Line	:	2720 169TH ST
Second Line	:
City	:	HAMMOND
State	:	IN
Zip	:	46323-1508
Country	:	US
Telephone Number	:	219-845-2020
Fax Number	:	219-845-2012

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. GRISHMA P PATEL
Credential	:
Telephone Number	:	219-845-2020

Provider Enumeration Date	:	05/25/2009
Last Update Date	:	02/21/2024

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Directions to “UNIVERSITY EYE INSTITUTE PC ” Practice Location

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