Provider Demographics
NPI:1902910359
Name:INDIANAPOLIS OPHTHALMOLOGY PC
Entity Type:Organization
Organization Name:INDIANAPOLIS OPHTHALMOLOGY PC
Other - Org Name:ABRAMS EYECARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DILTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-819-0742
Mailing Address - Street 1:11455 N MERIDIAN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1624
Mailing Address - Country:US
Mailing Address - Phone:317-846-4223
Mailing Address - Fax:317-846-6063
Practice Address - Street 1:11455 N MERIDIAN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1624
Practice Address - Country:US
Practice Address - Phone:317-846-4223
Practice Address - Fax:317-846-6063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034454A207W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100056740Medicaid
IN0302550003Medicare NSC
IN318010Medicare PIN
IN100056740Medicaid
IN0302550002Medicare NSC