MEDICARE: OPHTHALMIC PLASTIC SURGERY 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

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	:	1831129790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPHTHALMIC PLASTIC SURGERY INC

Provider Business Mailing Address
First Line	:	10300 N ILLINOIS ST
Second Line	:	STE 2020
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1166
Country	:	US
Telephone Number	:	317-817-1976
Fax Number	:	317-817-1737

Provider Business Practice Location Address
First Line	:	10300 N ILLINOIS ST STE 2020
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1167
Country	:	US
Telephone Number	:	317-817-1976
Fax Number	:	317-817-1737

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL WELSH
Credential	:	MD
Telephone Number	:	317-817-1976

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	01/26/2024

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