MEDICARE: INDIANA UNIVERSITY EYE CARE, 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
1	207W00000X	Ophthalmology Physician		IN
2	152W00000X	Optometrist	18003053	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6760130003	OTHER	IN	NSC PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780928408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA UNIVERSITY EYE CARE, INC.

Provider Business Mailing Address
First Line	:	1160 W MICHIGAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5209
Country	:	US
Telephone Number	:	317-274-2020
Fax Number	:	317-274-3265

Provider Business Practice Location Address
First Line	:	1001 HADLEY RD
Second Line	:	SUITE 103
City	:	MOORESVILLE
State	:	IN
Zip	:	46158-1883
Country	:	US
Telephone Number	:	317-274-2020
Fax Number	:	317-274-3265

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	DR. LOUIS B CANTOR
Credential	:	M.D.
Telephone Number	:	317-278-2651

Provider Enumeration Date	:	11/19/2012
Last Update Date	:	07/01/2013

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