Provider Demographics
NPI:1942517800
Name:E S T INC
Entity Type:Organization
Organization Name:E S T INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-273-2020
Mailing Address - Street 1:441 GREEN RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-2645
Mailing Address - Country:US
Mailing Address - Phone:812-273-2020
Mailing Address - Fax:812-273-4022
Practice Address - Street 1:441 GREEN RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-2645
Practice Address - Country:US
Practice Address - Phone:812-273-2020
Practice Address - Fax:812-273-4022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001510A152W00000X
IN18001655A152W00000X
IN18001637A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN135060Medicare PIN
IN144770Medicare PIN
IN144710Medicare PIN
IN144690Medicare PIN
IN144680Medicare PIN
IN138240Medicare PIN
IN138270Medicare PIN
IN144650Medicare PIN
144700Medicare PIN