Provider Demographics
NPI:1093778052
Name:MIDWEST EYE CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:MIDWEST EYE CONSULTANTS, P.C.
Other - Org Name:CLI SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES./CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:260-569-9550
Mailing Address - Street 1:7747 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4135
Mailing Address - Country:US
Mailing Address - Phone:260-434-9104
Mailing Address - Fax:260-434-9105
Practice Address - Street 1:7747 W JEFFERSON BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4135
Practice Address - Country:US
Practice Address - Phone:260-434-9104
Practice Address - Fax:260-434-9105
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST EYE CONSULTANTS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-10
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200421610AMedicaid
INP00021986Medicare PIN
IN200421610AMedicaid