Provider Demographics
NPI:1992999106
Name:NORTHWEST INDIANA EYE ASSOCIATES, PC
Entity type:Organization
Organization Name:NORTHWEST INDIANA EYE ASSOCIATES, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRON
Authorized Official - Middle Name:I
Authorized Official - Last Name:LEWYCKYJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-462-0309
Mailing Address - Street 1:2101 BURLINGTON BEACH RD.
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-1665
Mailing Address - Country:US
Mailing Address - Phone:219-462-0309
Mailing Address - Fax:219-464-4291
Practice Address - Street 1:297 W. FRANCISCAN DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-4858
Practice Address - Country:US
Practice Address - Phone:219-662-0999
Practice Address - Fax:219-662-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2015-02-13
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
IN100315020Medicaid
IN656540Medicare PIN
IN656510Medicare PIN
IN0379430005Medicare NSC