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NPI Code Detail

MEDICARE: CITY OPTICAL CO., INC.

MEDICARE: CITY OPTICAL CO., 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
1152W00000XOptometrist18002855IN
2152W00000XOptometrist

Other Identifiers

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

General Provider Information

NPI Number : 1700875887
Entity Type Code : Organization
Provider Name (Legal Business Name) : CITY OPTICAL CO., INC.
Provider Business Mailing Address
First Line : 2839 LAFAYETTE RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46222-2147
Country : US
Telephone Number : 317-924-1300
Fax Number : 317-924-3741
Provider Business Practice Location Address
First Line : 8139 PENDLETON PIKE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46226-4014
Country : US
Telephone Number : 317-898-2020
Fax Number : 317-924-3741
Authorized Official
Title or Position : PRESIDENT
Name : DR. LARRY S TAVEL
Credential : MD
Telephone Number : 317-924-1300
Provider Enumeration Date : 10/20/2005
Last Update Date : 10/27/2021

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Directions to “CITY OPTICAL CO., INC. ” Practice Location

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