Provider Demographics
NPI:1760996623
Name:INDIANA EYE INSTITUTE LLC
Entity Type:Organization
Organization Name:INDIANA EYE INSTITUTE LLC
Other - Org Name:INDIANA EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEELA
Authorized Official - Middle Name:MASOOD
Authorized Official - Last Name:ALIZAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-252-4551
Mailing Address - Street 1:2235 CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-3529
Mailing Address - Country:US
Mailing Address - Phone:574-647-3580
Mailing Address - Fax:574-647-3585
Practice Address - Street 1:2235 CLEVELAND RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-3529
Practice Address - Country:US
Practice Address - Phone:574-647-3580
Practice Address - Fax:574-647-3585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmologyGroup - Single Specialty