Provider Demographics
NPI:1578664181
Name:MEDICAL ARTS OPTICAL
Entity Type:Organization
Organization Name:MEDICAL ARTS OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-353-9321
Mailing Address - Street 1:1400 N RITTER AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3052
Mailing Address - Country:US
Mailing Address - Phone:317-353-9321
Mailing Address - Fax:317-357-5383
Practice Address - Street 1:1400 N RITTER AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3052
Practice Address - Country:US
Practice Address - Phone:317-353-9321
Practice Address - Fax:317-357-5383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31426156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN31426OtherLICENSE