Provider Demographics
NPI:1639285844
Name:MERRILLVILLE EYE CLINIC, INC
Entity Type:Organization
Organization Name:MERRILLVILLE EYE CLINIC, INC
Other - Org Name:MERRILLVILLE EYE CLINIC, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:H
Authorized Official - Last Name:ROIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-769-3555
Mailing Address - Street 1:8518 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7032
Mailing Address - Country:US
Mailing Address - Phone:219-769-3555
Mailing Address - Fax:219-769-3572
Practice Address - Street 1:8518 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7032
Practice Address - Country:US
Practice Address - Phone:219-769-3555
Practice Address - Fax:219-769-3572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty