Provider Demographics
NPI:1114064680
Name:GRANGER FAMILY EYECARE INC
Entity Type:Organization
Organization Name:GRANGER FAMILY EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SVATOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:574-247-1500
Mailing Address - Street 1:13197 STATE ROAD 23
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530
Mailing Address - Country:US
Mailing Address - Phone:574-247-1500
Mailing Address - Fax:574-247-1505
Practice Address - Street 1:13197 STATE ROAD 23
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530
Practice Address - Country:US
Practice Address - Phone:574-247-1500
Practice Address - Fax:574-247-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002580152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000277906OtherANTHEM BCBS
IN410049816OtherMEDICARE RAILROAD
IN410049816OtherMEDICARE RAILROAD
IN200670Medicare PIN