Provider Demographics
NPI:1861686099
Name:NORTHWEST INDIANA EYE ASSOCIATES, PC
Entity Type:Organization
Organization Name:NORTHWEST INDIANA EYE ASSOCIATES, PC
Other - Org Name:D/B/A LEWYCKYJ-TAGLIA-FELTON EYE CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:I
Authorized Official - Last Name:LEWYCKYJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-462-0309
Mailing Address - Street 1:2101 BURLINGTON BEACH RD.
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-1665
Mailing Address - Country:US
Mailing Address - Phone:219-462-0309
Mailing Address - Fax:219-464-4291
Practice Address - Street 1:701 SUPERIOR AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4037
Practice Address - Country:US
Practice Address - Phone:219-934-0150
Practice Address - Fax:219-934-0152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100315020Medicaid
IN656510Medicare PIN
IN656540Medicare PIN
IN100315020Medicaid