| |
521 Broadway, Gary, IN 46402-1910 | |
(219) 882-9397 | |
(219) 882-9649 |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 521 Broadway, Gary, Indiana |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1295858371 | NPI | - | NPPES |
100215150C | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
521 Broadway, Gary, IN 46402-1910 Ph: (219) 882-9397 | 521 Broadway, Gary, IN 46402-1910 Ph: (219) 882-9397 |