Provider Demographics
NPI:1750495263
Name:COMPREHENSIVE EYE CARE OF INDIANA PC
Entity Type:Organization
Organization Name:COMPREHENSIVE EYE CARE OF INDIANA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:MCCORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-845-1305
Mailing Address - Street 1:6418 LANDBOROUGH SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4357
Mailing Address - Country:US
Mailing Address - Phone:317-845-1305
Mailing Address - Fax:317-842-3621
Practice Address - Street 1:7301 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2085
Practice Address - Country:US
Practice Address - Phone:317-845-1305
Practice Address - Fax:317-842-3621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003808A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000104148OtherANTHEM BLUE NETWORK
317426300OtherTRICARE CHAMPUS
IN000000104148OtherANTHEM BLUE NETWORK
IN000000104148OtherANTHEM BLUE NETWORK
1174910001Medicare NSC
248220Medicare PIN