Provider Demographics
NPI:1497082598
Name:GLAUCOMA CENTER INC
Entity Type:Organization
Organization Name:GLAUCOMA CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AJIT
Authorized Official - Middle Name:K
Authorized Official - Last Name:TIWARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-281-1181
Mailing Address - Street 1:3700 N EVERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5269
Mailing Address - Country:US
Mailing Address - Phone:765-281-1181
Mailing Address - Fax:765-282-4768
Practice Address - Street 1:3700 N EVERBROOK LN
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5269
Practice Address - Country:US
Practice Address - Phone:765-281-1181
Practice Address - Fax:765-282-4768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039897A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100094420EMedicaid
000000219038OtherANTHEM
666840OtherMEDICARE PTN
IN100094420EMedicaid
000000219038OtherANTHEM