MEDICARE: MIDWEST EYE CONSULTANTS, P.C.

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	56000164A	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	:	1649654526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST EYE CONSULTANTS, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 549
Second Line	:
City	:	WABASH
State	:	IN
Zip	:	46992-0549
Country	:	US
Telephone Number	:	260-569-9550
Fax Number	:	260-569-0760

Provider Business Practice Location Address
First Line	:	2874 E DUPONT RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1669
Country	:	US
Telephone Number	:	260-490-1631
Fax Number	:

Authorized Official
Title or Position	:	PRES/CEO
Name	:	GREGORY L GARNER
Credential	:	OD
Telephone Number	:	260-569-9550

Provider Enumeration Date	:	07/10/2015
Last Update Date	:	04/18/2016

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