MEDICARE: SVS OPHTHALMOLOGY, 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	01065082A	IN

General Provider Information

NPI Number	:	1962632158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SVS OPHTHALMOLOGY, LLC

Provider Business Mailing Address
First Line	:	200 W 103RD ST
Second Line	:	SUITE 1000
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1092
Country	:	US
Telephone Number	:	317-817-1254
Fax Number	:	317-817-1027

Provider Business Practice Location Address
First Line	:	200 W 103RD ST
Second Line	:	SUITE 1000
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1092
Country	:	US
Telephone Number	:	317-817-1254
Fax Number	:	317-817-1027

Authorized Official
Title or Position	:	SINGLE MEMBER
Name	:	DR. SEEMA VISHNU SUNDARAM
Credential	:	MD
Telephone Number	:	317-858-3634

Provider Enumeration Date	:	07/22/2009
Last Update Date	:	07/22/2009

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