Provider Demographics
NPI:1700950920
Name:DESCHAMPS EYE CARE PC
Entity Type:Organization
Organization Name:DESCHAMPS EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ELDI
Authorized Official - Middle Name:E
Authorized Official - Last Name:DESCHAMPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-736-2200
Mailing Address - Street 1:8510 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410
Mailing Address - Country:US
Mailing Address - Phone:219-736-2200
Mailing Address - Fax:219-736-2222
Practice Address - Street 1:8510 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-736-2200
Practice Address - Fax:219-736-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN629310Medicare ID - Type Unspecified
IN0231510001Medicare NSC