Provider Demographics
NPI:1679822035
Name:CENTER FOR EYE-CARE EXCELLENCE LLC
Entity Type:Organization
Organization Name:CENTER FOR EYE-CARE EXCELLENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KINTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-255-3188
Mailing Address - Street 1:517 LINCOLNWAY E
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2211
Mailing Address - Country:US
Mailing Address - Phone:574-255-3188
Mailing Address - Fax:574-255-4182
Practice Address - Street 1:517 LINCOLNWAY E
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-2211
Practice Address - Country:US
Practice Address - Phone:574-255-3188
Practice Address - Fax:574-255-4182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002941B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU70861Medicare UPIN
INU35214Medicare UPIN
U95890Medicare UPIN