Provider Demographics
NPI:1356881262
Name:MEC OPTOMETRY LLC
Entity type:Organization
Organization Name:MEC OPTOMETRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KYSER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:574-583-9311
Mailing Address - Street 1:501 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IN
Mailing Address - Zip Code:47960-2006
Mailing Address - Country:US
Mailing Address - Phone:574-583-9311
Mailing Address - Fax:574-583-4939
Practice Address - Street 1:501 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IN
Practice Address - Zip Code:47960-2006
Practice Address - Country:US
Practice Address - Phone:574-583-9311
Practice Address - Fax:574-583-4939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002694AB152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty