Provider Demographics
NPI:1912960535
Name:MIDWEST EYE CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:MIDWEST EYE CONSULTANTS, P.C.
Other - Org Name:CATARACT & LASER INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES./CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:260-569-9550
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-0549
Mailing Address - Country:US
Mailing Address - Phone:260-459-8444
Mailing Address - Fax:260-459-8443
Practice Address - Street 1:7747 W JEFFERSON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4135
Practice Address - Country:US
Practice Address - Phone:260-459-8444
Practice Address - Fax:260-459-8443
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MIDWEST EYE CONSULTANTS, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-07
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200190920BMedicaid
IN402670Medicare PIN
IN669220Medicare PIN
INCD2507Medicare PIN
IN402660Medicare PIN
IN200190920BMedicaid
INDA1994Medicare PIN
IN160450Medicare PIN