Provider Demographics
NPI:1336257542
Name:INDIANAPOLIS OPHTHALMOLOGY PC
Entity type:Organization
Organization Name:INDIANAPOLIS OPHTHALMOLOGY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DILTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-819-0742
Mailing Address - Street 1:1320 CITY CENTER DR STE 150
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3104
Mailing Address - Country:US
Mailing Address - Phone:317-846-4223
Mailing Address - Fax:317-846-6063
Practice Address - Street 1:1320 CITY CENTER DR STE 150
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3104
Practice Address - Country:US
Practice Address - Phone:317-846-4223
Practice Address - Fax:317-846-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100056740Medicaid