Provider Demographics
NPI:1033631098
Name:CATARACT VISION INSTITUTE INDIANA LLC
Entity Type:Organization
Organization Name:CATARACT VISION INSTITUTE INDIANA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:THIERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILBRANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-843-9300
Mailing Address - Street 1:1555 PALM BEACH LAKES BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-2333
Mailing Address - Country:US
Mailing Address - Phone:561-965-9110
Mailing Address - Fax:561-684-7754
Practice Address - Street 1:11595 NORTH MERIDIAN
Practice Address - Street 2:STE 175
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032
Practice Address - Country:US
Practice Address - Phone:317-843-9300
Practice Address - Fax:317-483-8309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ01033835AOtherSTATE LICENSE