Provider Demographics
NPI:1780789909
Name:20/20 EYE PHYSICIANS OF INDIANA, PC
Entity type:Organization
Organization Name:20/20 EYE PHYSICIANS OF INDIANA, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:IRELAND
Authorized Official - Suffix:
Authorized Official - Credentials:COA
Authorized Official - Phone:317-871-5900
Mailing Address - Street 1:2020 W 86TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1969
Mailing Address - Country:US
Mailing Address - Phone:317-871-5900
Mailing Address - Fax:317-872-6439
Practice Address - Street 1:4880 CENTURY PLAZA RD
Practice Address - Street 2:SUITE 140
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5469
Practice Address - Country:US
Practice Address - Phone:317-328-0901
Practice Address - Fax:317-328-5038
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:20/20 EYE PHYSICIANS OF INDIANA, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-13
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0003928578332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCB2286OtherRAILROAD MEDICARE
IN0301750001Medicare ID - Type Unspecified
IN0301750001Medicare NSC