Provider Demographics
NPI:1356065478
Name:MIDWEST OPTOMETRY SERVICES LLC
Entity type:Organization
Organization Name:MIDWEST OPTOMETRY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:EMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-841-0712
Mailing Address - Street 1:2007 E GREYHOUND PASS STE 4
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-7753
Mailing Address - Country:US
Mailing Address - Phone:317-841-0712
Mailing Address - Fax:
Practice Address - Street 1:2852 E 3RD ST SPC L07
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5423
Practice Address - Country:US
Practice Address - Phone:812-334-1872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center