Provider Demographics
NPI:1255478491
Name:INDIANA VISION IMPROVEMENT CENTER
Entity Type:Organization
Organization Name:INDIANA VISION IMPROVEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-882-1527
Mailing Address - Street 1:1250 E COUNTY LINE RD
Mailing Address - Street 2:SUITE4
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1004
Mailing Address - Country:US
Mailing Address - Phone:317-882-1527
Mailing Address - Fax:317-882-4092
Practice Address - Street 1:1250 E COUNTY LINE RD
Practice Address - Street 2:SUITE4
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1004
Practice Address - Country:US
Practice Address - Phone:317-882-1527
Practice Address - Fax:317-882-4092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN264310Medicare ID - Type UnspecifiedPRACTICE ID #
IN0419720001Medicare NSC
INT69240Medicare UPIN
IN264310CMedicare ID - Type Unspecified