Provider Demographics
NPI:1346358439
Name:VALERIE A PURVIN MD PC
Entity Type:Organization
Organization Name:VALERIE A PURVIN MD PC
Other - Org Name:INDIANA NEURO OPHTHALMOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PURVIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-817-1254
Mailing Address - Street 1:201 PENNSYLVANIA PARKWAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46280-1381
Mailing Address - Country:US
Mailing Address - Phone:317-817-1254
Mailing Address - Fax:317-817-1027
Practice Address - Street 1:201 PENNSYLVANIA PARKWAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-1381
Practice Address - Country:US
Practice Address - Phone:317-817-1254
Practice Address - Fax:317-817-1027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010330112084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100277940Medicaid
IN100277940Medicaid
229010Medicare PIN
B29535Medicare UPIN