Provider Demographics
NPI:1083890172
Name:SUPERIOR VISION, LLC
Entity Type:Organization
Organization Name:SUPERIOR VISION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:O.D./PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-320-4362
Mailing Address - Street 1:8190 WINDFALL LN
Mailing Address - Street 2:STE C
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-7906
Mailing Address - Country:US
Mailing Address - Phone:317-856-2000
Mailing Address - Fax:317-865-2000
Practice Address - Street 1:10922 E COUNTY ROAD 800 S STE A
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-9161
Practice Address - Country:US
Practice Address - Phone:317-856-2000
Practice Address - Fax:317-865-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002637B261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200893590Medicaid
IN200893590Medicaid
177200Medicare PIN