Provider Demographics
NPI:1457399834
Name:EYE SURGEONS OF INDIANA, PC
Entity type:Organization
Organization Name:EYE SURGEONS OF INDIANA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-841-2020
Mailing Address - Street 1:9202 N MERIDIAN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1810
Mailing Address - Country:US
Mailing Address - Phone:317-841-2020
Mailing Address - Fax:317-570-7433
Practice Address - Street 1:9202 N MERIDIAN ST STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1810
Practice Address - Country:US
Practice Address - Phone:317-841-2020
Practice Address - Fax:317-570-7433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100217740AMedicaid
IN673220Medicare ID - Type UnspecifiedOD NUMBER