Provider Demographics
NPI:1073010146
Name:INDY EYES, LLC
Entity Type:Organization
Organization Name:INDY EYES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF BILLING AND INSURANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHILLABAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-453-3777
Mailing Address - Street 1:3433 S LAFOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3801
Mailing Address - Country:US
Mailing Address - Phone:765-453-3777
Mailing Address - Fax:765-453-6577
Practice Address - Street 1:322 W MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9384
Practice Address - Country:US
Practice Address - Phone:765-453-3777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EYE PHYSICIANS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-06
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty