Provider Demographics
NPI:1326893348
Name:INDIANA VISION GROUP, LLC
Entity Type:Organization
Organization Name:INDIANA VISION GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:REICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-852-7660
Mailing Address - Street 1:1901 CLUNE STUCKE RD
Mailing Address - Street 2:
Mailing Address - City:MARIA STEIN
Mailing Address - State:OH
Mailing Address - Zip Code:45860-9724
Mailing Address - Country:US
Mailing Address - Phone:419-852-7660
Mailing Address - Fax:
Practice Address - Street 1:882 SE GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:IN
Practice Address - Zip Code:47394-9293
Practice Address - Country:US
Practice Address - Phone:765-584-1320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty