Provider Demographics
NPI:1942349287
Name:EYE SPECIALIST OF INDIANA, P.C.
Entity Type:Organization
Organization Name:EYE SPECIALIST OF INDIANA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPT MGR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STAHL
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CCS-P, CPC-H
Authorized Official - Phone:317-920-4575
Mailing Address - Street 1:1901 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1303
Mailing Address - Country:US
Mailing Address - Phone:317-925-2200
Mailing Address - Fax:
Practice Address - Street 1:1101 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2147
Practice Address - Country:US
Practice Address - Phone:317-738-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003538A152W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN596360Medicare ID - Type Unspecified
IN595540Medicare ID - Type Unspecified