Provider Demographics
NPI:1770816142
Name:EYE SPECIALISTS OF EAST CENTRAL INDIANA, LLC
Entity Type:Organization
Organization Name:EYE SPECIALISTS OF EAST CENTRAL INDIANA, LLC
Other - Org Name:MUNCIE EYE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SCANAMEO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-286-8888
Mailing Address - Street 1:200 N TILLOTSON AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-3988
Mailing Address - Country:US
Mailing Address - Phone:765-286-8888
Mailing Address - Fax:765-966-2975
Practice Address - Street 1:200 N TILLOTSON AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-3988
Practice Address - Country:US
Practice Address - Phone:765-286-8888
Practice Address - Fax:765-966-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty