Provider Demographics
NPI:1104608348
Name:REVOLUTIONEYES 2 LLC
Entity type:Organization
Organization Name:REVOLUTIONEYES 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-790-2015
Mailing Address - Street 1:11464 LAKERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7607
Mailing Address - Country:US
Mailing Address - Phone:317-790-2015
Mailing Address - Fax:317-708-7324
Practice Address - Street 1:11464 LAKERIDGE DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7607
Practice Address - Country:US
Practice Address - Phone:317-790-2015
Practice Address - Fax:317-708-7324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty