Potter Family Eye Care | |
5953 W Broadway, Mc Cordsville, IN 46055-9355 | |
(317) 747-9263 | |
(317) 747-9271 |
Full Name | Potter Family Eye Care |
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Type | Facility |
Speciality | Optometrist |
Location | 5953 W Broadway, Mc Cordsville, Indiana |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1801198510 | NPI | - | NPPES |
6592970001 | Other | IN | MEDICARE DMEPOS PTAN |
M100047360 | Other | IN | MEDICARE PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 18003358A (Indiana) | Primary |
332H00000X | Eyewear Supplier | 18003358A (Indiana) | Secondary |
Provider Name | Austin David Potter |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1508870742 PECOS PAC ID: 2062597941 Enrollment ID: I20080318000045 |
Provider Name | Elizabeth M Leburg |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1659668978 PECOS PAC ID: 4284803123 Enrollment ID: I20110809000820 |
Mailing Address | Practice Location Address |
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Potter Family Eye Care 5953 W Broadway, Mc Cordsville, IN 46055-9355 Ph: (317) 747-9263 | Potter Family Eye Care 5953 W Broadway, Mc Cordsville, IN 46055-9355 Ph: (317) 747-9263 |
Dr. Austin David Potter, O.D. Optometrist Medicare: Accepting Medicare Assignments Practice Location: 5953 W Broadway, Mc Cordsville, IN 46055 Phone: 317-747-9263 Fax: 317-747-9271 |