Provider Demographics
NPI:1841833142
Name:ELITE VISION CONSULTANTS
Entity type:Organization
Organization Name:ELITE VISION CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:KOSSIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:216-789-9066
Mailing Address - Street 1:123 N MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-4077
Mailing Address - Country:US
Mailing Address - Phone:219-310-2723
Mailing Address - Fax:
Practice Address - Street 1:123 N MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4077
Practice Address - Country:US
Practice Address - Phone:219-310-2723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN210361680Medicaid
1962859512OtherPROVIDER NPI