Provider Demographics
NPI:1548332794
Name:PLAINFIELD EYE CARE PC
Entity type:Organization
Organization Name:PLAINFIELD EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-839-2368
Mailing Address - Street 1:900 EDWARDS DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-5680
Mailing Address - Country:US
Mailing Address - Phone:317-839-2368
Mailing Address - Fax:317-839-1267
Practice Address - Street 1:900 EDWARDS DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-5680
Practice Address - Country:US
Practice Address - Phone:317-839-2368
Practice Address - Fax:317-839-1267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN56000039152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN410023331Medicare PIN
IN0217050002Medicare NSC
IN341220Medicare PIN