Provider Demographics
NPI:1316016207
Name:COMMUNITY EYE CARE OF INDIANA, INC
Entity Type:Organization
Organization Name:COMMUNITY EYE CARE OF INDIANA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LATONA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-594-9410
Mailing Address - Street 1:1400 N RITTER AVE
Mailing Address - Street 2:STE 281
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3052
Mailing Address - Country:US
Mailing Address - Phone:317-357-8663
Mailing Address - Fax:317-357-5383
Practice Address - Street 1:7250 CLEARVISTA DR
Practice Address - Street 2:STE 180
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-4692
Practice Address - Country:US
Practice Address - Phone:317-594-9410
Practice Address - Fax:317-357-5383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003340A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDC5434OtherMEDICARE ID
IN200275230AMedicaid
IN200275230BMedicaid
IN200275230BMedicaid
INDC5434OtherMEDICARE ID