Provider Demographics
NPI:1760996623
Name:MICHIANA EYE INSTITUTE LLC
Entity type:Organization
Organization Name:MICHIANA EYE INSTITUTE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-229-3519
Mailing Address - Street 1:3809 N MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3109
Mailing Address - Country:US
Mailing Address - Phone:574-520-1700
Mailing Address - Fax:833-989-0916
Practice Address - Street 1:INDIANA EYE INSTITUTE ATTENTION : DR ADEELA M. ALIZAI
Practice Address - Street 2:2335 CLEVELAND ROAD
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628
Practice Address - Country:US
Practice Address - Phone:219-252-4551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmologyGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty