Provider Demographics
NPI:1124147947
Name:METROPOLITAN EYECARE CENTER OF ST. JOHN
Entity type:Organization
Organization Name:METROPOLITAN EYECARE CENTER OF ST. JOHN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:219-365-7200
Mailing Address - Street 1:9488 WICKER AVE # A
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9400
Mailing Address - Country:US
Mailing Address - Phone:219-365-7200
Mailing Address - Fax:219-365-7207
Practice Address - Street 1:9488 WICKER AVE # A
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-9400
Practice Address - Country:US
Practice Address - Phone:219-365-7200
Practice Address - Fax:219-365-7207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty