Provider Demographics
NPI:1730204785
Name:INSIGHTS OPTICAL, INC.
Entity type:Organization
Organization Name:INSIGHTS OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-333-1911
Mailing Address - Street 1:415 S CLARIZZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5517
Mailing Address - Country:US
Mailing Address - Phone:812-333-1911
Mailing Address - Fax:812-333-1602
Practice Address - Street 1:415 S CLARIZZ BLVD
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5517
Practice Address - Country:US
Practice Address - Phone:812-333-1911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200892090Medicaid
INDO6083OtherRR MEDICARE
IN0909890001Medicare NSC