Provider Demographics
NPI:1639286040
Name:MIDWEST EYE CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:MIDWEST EYE CONSULTANTS, P.C.
Other - Org Name:INDIANA LASIK CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES./CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-569-9550
Mailing Address - Street 1:2510 E. DUPONT RD.
Mailing Address - Street 2:SUITE 124
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825
Mailing Address - Country:US
Mailing Address - Phone:260-497-8000
Mailing Address - Fax:
Practice Address - Street 1:2510 E. DUPONT RD.
Practice Address - Street 2:SUITE 124
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825
Practice Address - Country:US
Practice Address - Phone:260-497-8000
Practice Address - Fax:260-497-0699
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST EYE CONSULTANTS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-23
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery