Provider Demographics
NPI:1710372685
Name:LF EYES LLC
Entity Type:Organization
Organization Name:LF EYES LLC
Other - Org Name:LINDA FUNDENBERGER MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNDENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-547-5525
Mailing Address - Street 1:2815 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-1229
Mailing Address - Country:US
Mailing Address - Phone:317-547-5525
Mailing Address - Fax:317-543-0948
Practice Address - Street 1:2815 E 38TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-1229
Practice Address - Country:US
Practice Address - Phone:317-547-5525
Practice Address - Fax:317-543-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-30
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036129207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100176610AMedicaid
IN100176610AMedicaid