Provider Demographics
NPI:1881833960
Name:TAVEL & ENGELBERG OPTOMETRISTS, INC.
Entity Type:Organization
Organization Name:TAVEL & ENGELBERG OPTOMETRISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:ENGELBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-293-5424
Mailing Address - Street 1:5685 LAFAYETTE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-6170
Mailing Address - Country:US
Mailing Address - Phone:317-293-5424
Mailing Address - Fax:317-291-8861
Practice Address - Street 1:5685 LAFAYETTE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-6170
Practice Address - Country:US
Practice Address - Phone:317-293-5424
Practice Address - Fax:317-291-8861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0775450001Medicare NSC
IN118110Medicare PIN