Provider Demographics
NPI:1326210964
Name:OSSIP OPTOMETRY, PC
Entity Type:Organization
Organization Name:OSSIP OPTOMETRY, PC
Other - Org Name:OSSIP OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:L
Authorized Official - Last Name:OSSIP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-254-6480
Mailing Address - Street 1:9795 CROSSPOINT BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3354
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:3965 W 106TH ST
Practice Address - Street 2:STE 120
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7750
Practice Address - Country:US
Practice Address - Phone:317-875-9339
Practice Address - Fax:317-875-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001622A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN894060Medicare PIN