Provider Demographics
NPI:1558596247
Name:UNIVERSITY EYE INSTITUTE PC
Entity Type:Organization
Organization Name:UNIVERSITY EYE INSTITUTE PC
Other - Org Name:UNIVERSITY EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GRISHMA
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-845-2020
Mailing Address - Street 1:2720 169TH ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46323-1508
Mailing Address - Country:US
Mailing Address - Phone:219-845-2020
Mailing Address - Fax:219-845-2012
Practice Address - Street 1:2720 169TH ST
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46323-1508
Practice Address - Country:US
Practice Address - Phone:219-845-2020
Practice Address - Fax:219-845-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-25
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003569A152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009678Medicaid
IN200962790Medicaid
IN264170Medicare PIN
IN6364360001Medicare NSC