Provider Demographics
NPI:1326077603
Name:OPTOMETRIC MANAGEMENT SERVICES INC
Entity Type:Organization
Organization Name:OPTOMETRIC MANAGEMENT SERVICES INC
Other - Org Name:OPTIX OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:765-743-3132
Mailing Address - Street 1:1850 SAGAMORE PKWY W
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-1368
Mailing Address - Country:US
Mailing Address - Phone:765-743-3132
Mailing Address - Fax:765-743-2455
Practice Address - Street 1:1850 SAGAMORE PKWY W
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-1368
Practice Address - Country:US
Practice Address - Phone:765-743-3132
Practice Address - Fax:765-743-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003043A332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1205190002Medicare NSC