MEDICARE: 20/20 EYE PHYSICIANS OF INDIANA, 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	332H00000X	Eyewear Supplier	0003928578	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CB2286	OTHER	IN	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1780789909
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	20/20 EYE PHYSICIANS OF INDIANA, PC

Provider Business Mailing Address
First Line	:	2020 W 86TH ST
Second Line	:	SUITE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1969
Country	:	US
Telephone Number	:	317-871-5900
Fax Number	:	317-872-6439

Provider Business Practice Location Address
First Line	:	4880 CENTURY PLAZA RD
Second Line	:	SUITE 140
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-5469
Country	:	US
Telephone Number	:	317-328-0901
Fax Number	:	317-328-5038

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	DONNA M IRELAND
Credential	:	COA
Telephone Number	:	317-871-5900

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	03/31/2021

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Directions to “20/20 EYE PHYSICIANS OF INDIANA, PC ” Practice Location

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