Provider Demographics
NPI:1902154842
Name:INDIANA UNIVERSITY EYE CARE, INC.
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY EYE CARE, INC.
Other - Org Name:IU EYE CARE INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:CANTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-278-2651
Mailing Address - Street 1:1160 W MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5209
Mailing Address - Country:US
Mailing Address - Phone:317-274-2020
Mailing Address - Fax:317-274-3265
Practice Address - Street 1:2705 N LEBANON ST
Practice Address - Street 2:SUITE 230
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-8621
Practice Address - Country:US
Practice Address - Phone:317-274-2020
Practice Address - Fax:317-274-3265
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIANA UNIVERSITY EYE CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-27
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003053152W00000X
IN207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6760130001OtherNSC PTAN
IN100067460Medicaid
IN094500Medicare PIN