Provider Demographics
NPI:1033242367
Name:MOODY EYES LLC
Entity Type:Organization
Organization Name:MOODY EYES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:D
Authorized Official - Middle Name:PENN
Authorized Official - Last Name:MOODY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-883-1122
Mailing Address - Street 1:8936 SOUTHPOINTE DR
Mailing Address - Street 2:SUITE C-5
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-7507
Mailing Address - Country:US
Mailing Address - Phone:317-883-1122
Mailing Address - Fax:317-883-1139
Practice Address - Street 1:8936 SOUTHPOINTE DR
Practice Address - Street 2:SUITE C-5
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-7507
Practice Address - Country:US
Practice Address - Phone:317-883-1122
Practice Address - Fax:317-883-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001808B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT34941Medicare UPIN