Provider Demographics
NPI:1477977924
Name:OSSIP OPTOMETRY, PC
Entity Type:Organization
Organization Name:OSSIP OPTOMETRY, PC
Other - Org Name:COHEN EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:L
Authorized Official - Last Name:OSSIP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-254-6480
Mailing Address - Street 1:9795 CROSSPOINT BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3354
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:2901 S MCINTIRE DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4209
Practice Address - Country:US
Practice Address - Phone:812-332-1401
Practice Address - Fax:812-332-3062
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OSSIP OPTOMETRY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-04
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN894060Medicare PIN