Provider Demographics
NPI:1659687754
Name:ZIONSVILLE EYECARE LLC
Entity Type:Organization
Organization Name:ZIONSVILLE EYECARE LLC
Other - Org Name:ZIONSVILLE EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-873-3000
Mailing Address - Street 1:1120 W OAK ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1259
Mailing Address - Country:US
Mailing Address - Phone:317-873-3000
Mailing Address - Fax:317-733-2020
Practice Address - Street 1:1120 W OAK ST STE 100
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1259
Practice Address - Country:US
Practice Address - Phone:317-873-3000
Practice Address - Fax:317-733-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-26
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001818152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200402290AMedicaid
IN0436820001Medicare NSC
IN194640Medicare Oscar/Certification