Provider Demographics
NPI:1356447007
Name:LAPORTE FAMILY VISION INC
Entity Type:Organization
Organization Name:LAPORTE FAMILY VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER & PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEYNE-THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:219-326-7681
Mailing Address - Street 1:1231 N STATE ROAD 39
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-2042
Mailing Address - Country:US
Mailing Address - Phone:219-326-7681
Mailing Address - Fax:
Practice Address - Street 1:1231 N STATE ROAD 39
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-2042
Practice Address - Country:US
Practice Address - Phone:219-326-7681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002633 A & B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN247510OtherPTAN
IN5787640001Medicare NSC
INU44059Medicare UPIN
IN247510OtherPTAN