Provider Demographics
NPI:1225369572
Name:NORTHWEST INDIANA EYE & LASER CENTER PC
Entity Type:Organization
Organization Name:NORTHWEST INDIANA EYE & LASER CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:A
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-464-8223
Mailing Address - Street 1:502 MARQUETTE ST
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2509
Mailing Address - Country:US
Mailing Address - Phone:219-464-8223
Mailing Address - Fax:219-531-2356
Practice Address - Street 1:1001 S EDGEWOOD DR
Practice Address - Street 2:SUITE 5
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-8269
Practice Address - Country:US
Practice Address - Phone:574-772-2012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048897A152W00000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty