Provider Demographics
NPI:1821146036
Name:OPTIQUE VISION CENTER INC
Entity Type:Organization
Organization Name:OPTIQUE VISION CENTER INC
Other - Org Name:OPTIQUE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:HINKLE
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-823-9985
Mailing Address - Street 1:8170 OAKLANDON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-9543
Mailing Address - Country:US
Mailing Address - Phone:317-823-9985
Mailing Address - Fax:317-823-9984
Practice Address - Street 1:8170 OAKLANDON RD
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-9543
Practice Address - Country:US
Practice Address - Phone:317-823-9985
Practice Address - Fax:317-823-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001867A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM100018671Medicare PIN