Provider Demographics
NPI:1932388816
Name:SWEET OBENAUF EYECARE
Entity Type:Organization
Organization Name:SWEET OBENAUF EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:K
Authorized Official - Last Name:OBENAUF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-577-9200
Mailing Address - Street 1:9760 LANTERN RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9612
Mailing Address - Country:US
Mailing Address - Phone:317-577-9200
Mailing Address - Fax:317-570-4434
Practice Address - Street 1:9760 LANTERN RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9612
Practice Address - Country:US
Practice Address - Phone:317-577-9200
Practice Address - Fax:317-570-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002369152W00000X
IN18002527152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
317330Medicare PIN