Provider Demographics
NPI:1497917199
Name:HERKERT FAMILY EYE CARE, P.C.
Entity Type:Organization
Organization Name:HERKERT FAMILY EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERKERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-784-5665
Mailing Address - Street 1:6904 S EAST ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2693
Mailing Address - Country:US
Mailing Address - Phone:317-784-5665
Mailing Address - Fax:317-784-7011
Practice Address - Street 1:6904 S EAST ST
Practice Address - Street 2:SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2693
Practice Address - Country:US
Practice Address - Phone:317-784-5665
Practice Address - Fax:317-784-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002512332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1265680001Medicare NSC