Provider Demographics
NPI:1437856291
Name:ILLUMINATE EYE CARE
Entity Type:Organization
Organization Name:ILLUMINATE EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:VIBHUTI
Authorized Official - Middle Name:
Authorized Official - Last Name:JANI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-242-9111
Mailing Address - Street 1:9774 E US HIGHWAY 36 STE C
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7979
Mailing Address - Country:US
Mailing Address - Phone:317-242-9111
Mailing Address - Fax:
Practice Address - Street 1:9774 E US HIGHWAY 36 STE C
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7979
Practice Address - Country:US
Practice Address - Phone:317-242-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty