Provider Demographics
NPI:1235846650
Name:NORTHEAST OPHTHALMOLOGY P C
Entity Type:Organization
Organization Name:NORTHEAST OPHTHALMOLOGY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-422-3937
Mailing Address - Street 1:3301 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-5529
Mailing Address - Country:US
Mailing Address - Phone:260-422-3937
Mailing Address - Fax:260-424-6900
Practice Address - Street 1:11277 TWIN CREEKS DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-2205
Practice Address - Country:US
Practice Address - Phone:260-422-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300062541Medicaid