Provider Demographics
NPI:1033324710
Name:EYE CENTER OF INDIANA INC
Entity Type:Organization
Organization Name:EYE CENTER OF INDIANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORWICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-247-1335
Mailing Address - Street 1:5912 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-6300
Mailing Address - Country:US
Mailing Address - Phone:317-247-1335
Mailing Address - Fax:317-247-1442
Practice Address - Street 1:5912 W 16TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-6300
Practice Address - Country:US
Practice Address - Phone:317-247-1335
Practice Address - Fax:317-247-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010133835A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND87676Medicare UPIN