Provider Demographics
NPI:1831129790
Name:OPHTHALMIC PLASTIC SURGERY INC
Entity Type:Organization
Organization Name:OPHTHALMIC PLASTIC SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WELSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-817-1976
Mailing Address - Street 1:10300 N ILLINOIS ST
Mailing Address - Street 2:STE 2020
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1166
Mailing Address - Country:US
Mailing Address - Phone:317-817-1976
Mailing Address - Fax:317-817-1737
Practice Address - Street 1:10300 N ILLINOIS ST STE 2020
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1167
Practice Address - Country:US
Practice Address - Phone:317-817-1976
Practice Address - Fax:317-817-1737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100065050Medicaid
IN100065050Medicaid