Provider Demographics
NPI:1558638973
Name:BIRTWHISTLE OPTOMETRY, INC.
Entity Type:Organization
Organization Name:BIRTWHISTLE OPTOMETRY, INC.
Other - Org Name:PROGRESSIVE EYECARE & EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BIRTWHISTLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-595-8855
Mailing Address - Street 1:3902 E 82ND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240
Mailing Address - Country:US
Mailing Address - Phone:317-595-8855
Mailing Address - Fax:317-595-8866
Practice Address - Street 1:3902 E 82ND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240
Practice Address - Country:US
Practice Address - Phone:317-595-8855
Practice Address - Fax:317-595-8866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003458152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty