MEDICARE: PANKRATZ EYE INSTITUTE, LLC

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	:	1871530642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANKRATZ EYE INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	3135 MIDDLE ROAD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-4472
Country	:	US
Telephone Number	:	812-373-7777
Fax Number	:	812-373-0772

Provider Business Practice Location Address
First Line	:	3135 MIDDLE ROAD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47203-4472
Country	:	US
Telephone Number	:	812-373-7777
Fax Number	:	812-373-0772

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	DR. MICHAEL JOSEPH PANKRATZ
Credential	:	M.D.
Telephone Number	:	812-373-7777

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	07/29/2008

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