Provider Demographics
NPI:1235274929
Name:BALOGH & CEDARSTAFF OPTOMETRISTS, P.C.
Entity Type:Organization
Organization Name:BALOGH & CEDARSTAFF OPTOMETRISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BALOGH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:219-924-6300
Mailing Address - Street 1:3737 45TH STREET
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322
Mailing Address - Country:US
Mailing Address - Phone:219-924-6300
Mailing Address - Fax:
Practice Address - Street 1:3737 45TH ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3008
Practice Address - Country:US
Practice Address - Phone:219-924-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002093A152W00000X
IN18001942A152W00000X
IN18002093B152W00000X
IN18001942B152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN251010Medicare PIN
IN0523610001Medicare NSC