Provider Demographics
NPI:1396905204
Name:MOORESVILLE FAMILY EYECARE, PC
Entity type:Organization
Organization Name:MOORESVILLE FAMILY EYECARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-831-0725
Mailing Address - Street 1:258 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-1638
Mailing Address - Country:US
Mailing Address - Phone:317-831-0725
Mailing Address - Fax:317-831-0734
Practice Address - Street 1:258 E HIGH ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1638
Practice Address - Country:US
Practice Address - Phone:317-831-0725
Practice Address - Fax:317-831-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1250520001332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1250520001Medicare NSC