Provider Demographics
NPI:1457482853
Name:JEROME D. MUSKAT, O.D., P.C.
Entity Type:Organization
Organization Name:JEROME D. MUSKAT, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MUSKAT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-849-4222
Mailing Address - Street 1:7411 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2077
Mailing Address - Country:US
Mailing Address - Phone:317-849-4222
Mailing Address - Fax:317-849-4241
Practice Address - Street 1:7411 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2077
Practice Address - Country:US
Practice Address - Phone:317-849-4222
Practice Address - Fax:317-849-4241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN56000155A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN094890Medicare UPIN