| |
1400 S Lake Park Ave, Suite 103, Hobart, IN 46342-6790 | |
(219) 947-4410 | |
(219) 942-7136 |
Full Name | |
---|---|
Type | Facility |
Speciality | Ophthalmology |
Location | 1400 S Lake Park Ave, Hobart, Indiana |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1265752927 | NPI | - | NPPES |
000000105018 | Other | IN | ANTHEM |
100169420 | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 50004042A (Indiana) | Secondary |
207W00000X | Ophthalmology | 50004042A (Indiana) | Primary |
Mailing Address | Practice Location Address |
---|---|
1400 S Lake Park Ave, Suite 103, Hobart, IN 46342-6790 Ph: (219) 947-4410 | 1400 S Lake Park Ave, Suite 103, Hobart, IN 46342-6790 Ph: (219) 947-4410 |