Provider Demographics
NPI:1528123460
Name:OSSIP, GREGG L (OD)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:L
Last Name:OSSIP
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9795 CROSSPOINT BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3354
Mailing Address - Country:US
Mailing Address - Phone:317-524-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:9795 CROSSPOINT BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3354
Practice Address - Country:US
Practice Address - Phone:317-524-6480
Practice Address - Fax:317-259-8609
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001899152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200063790Medicaid
IN200914970BMedicaid
IN894060AMedicare ID - Type Unspecified
IN200063790Medicaid