Provider Demographics
NPI:1912687674
Name:ELKHART OPHTHALMOLOGY, LLC
Entity Type:Organization
Organization Name:ELKHART OPHTHALMOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:SZYMAREK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-213-4343
Mailing Address - Street 1:10120 KESWICK CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-6041
Mailing Address - Country:US
Mailing Address - Phone:574-213-4343
Mailing Address - Fax:
Practice Address - Street 1:1628 W BEARDSLEY AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1881
Practice Address - Country:US
Practice Address - Phone:574-229-5205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty