Provider Demographics
NPI:1306928064
Name:OPHTHALMOLOGY INC
Entity type:Organization
Organization Name:OPHTHALMOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MANNIX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-362-6297
Mailing Address - Street 1:1300 STATE ST
Mailing Address - Street 2:STE. 1F
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3185
Mailing Address - Country:US
Mailing Address - Phone:219-362-6297
Mailing Address - Fax:219-324-3061
Practice Address - Street 1:1300 STATE ST
Practice Address - Street 2:STE. 1-F
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3185
Practice Address - Country:US
Practice Address - Phone:219-362-6297
Practice Address - Fax:219-324-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN483460Medicare ID - Type Unspecified