Provider Demographics
NPI:1528203270
Name:EYEQ OPTOMETRY P. C.
Entity Type:Organization
Organization Name:EYEQ OPTOMETRY P. C.
Other - Org Name:DR. LAWRENCE HEMINGWAY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:HEMINGWAY
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:317-848-4444
Mailing Address - Street 1:9302 N MERIDIAN ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1873
Mailing Address - Country:US
Mailing Address - Phone:317-848-4444
Mailing Address - Fax:317-848-7976
Practice Address - Street 1:9302 N MERIDIAN ST
Practice Address - Street 2:SUITE 150
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1873
Practice Address - Country:US
Practice Address - Phone:317-848-4444
Practice Address - Fax:317-848-7976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002591B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200495780Medicaid
IN263040Medicare PIN