Provider Demographics
NPI:1639353725
Name:OSSIP OPTOMETRY PC
Entity Type:Organization
Organization Name:OSSIP OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-254-6480
Mailing Address - Street 1:5455 HARRISON PARK LANE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:8411 WINDFALL LANE
Practice Address - Street 2:SUITE 130
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113
Practice Address - Country:US
Practice Address - Phone:317-821-3500
Practice Address - Fax:317-821-3533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
894060Medicare PIN
IN8014260006Medicare NSC