Masoud Ghohestani Od | |
100 Sycamore Estates Dr Aurora IN 47001 | |
(812) 926-4836 | |
(812) 926-4651 |
Full Name | Masoud Ghohestani Od |
---|---|
Speciality | Clinic/Center |
Location | 100 Sycamore Estates Dr, Aurora, Indiana |
Authorized Official Name and Position | Masoud Ghohestant (PRESIDENT) |
Authorized Official Contact | 8129264836 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Masoud Ghohestani Od Po Box 4174 Lawreneburg IN 47025-4174 Ph: (812) 926-4836 | Masoud Ghohestani Od 100 Sycamore Estates Dr Aurora IN 47001 Ph: (812) 926-4836 |
NPI Number | 1609829480 |
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Provider Enumeration Date | 05/19/2006 |
Last Update Date | 01/24/2024 |
Medicare PECOS PAC ID | 6608805528 |
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Medicare Enrollment ID | O20050810000763 |
Identifier | Type | State | Issuer |
---|---|---|---|
1609829480 | NPI | - | NPPES |
300024163 | Medicaid | IN | |
2278664 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Masoud Ghohestani |
---|---|
Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1013961457 PECOS PAC ID: 4688603509 Enrollment ID: I20050810000826 |
Provider Name | Keith W Blankman |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1447382593 PECOS PAC ID: 4880777523 Enrollment ID: I20080219000088 |
St. Elizabeth Physicians Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 204 Bridgeway St, Aurora, IN 47001 Phone: 812-926-3133 Fax: 812-926-1668 |