Provider Demographics
NPI:1225621071
Name:LOOGOOTEE EYE CENTER PC
Entity Type:Organization
Organization Name:LOOGOOTEE EYE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:260-415-0267
Mailing Address - Street 1:403 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:LOOGOOTEE
Mailing Address - State:IN
Mailing Address - Zip Code:47553-1424
Mailing Address - Country:US
Mailing Address - Phone:260-415-0267
Mailing Address - Fax:260-673-5875
Practice Address - Street 1:109 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LOOGOOTEE
Practice Address - State:IN
Practice Address - Zip Code:47553-1506
Practice Address - Country:US
Practice Address - Phone:260-415-0267
Practice Address - Fax:260-673-5875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-12
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200069410Medicaid