Provider Demographics
NPI:1770127342
Name:CENTER FOR EYE-CARE EXCELLENCE
Entity type:Organization
Organization Name:CENTER FOR EYE-CARE EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:JON
Authorized Official - Last Name:KINTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-255-1231
Mailing Address - Street 1:12806 STATE ROAD 23
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7894
Mailing Address - Country:US
Mailing Address - Phone:574-255-3188
Mailing Address - Fax:
Practice Address - Street 1:12806 STATE ROAD 23
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-7894
Practice Address - Country:US
Practice Address - Phone:574-440-8600
Practice Address - Fax:574-387-5118
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR EYE-CARE EXCELLENCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-06
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty