Provider Demographics
NPI:1043484660
Name:VASILIS MAKRIS MD, PC
Entity type:Organization
Organization Name:VASILIS MAKRIS MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VASILIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-939-2020
Mailing Address - Street 1:3300 W PURDUE AVE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-6355
Mailing Address - Country:US
Mailing Address - Phone:765-287-9579
Mailing Address - Fax:765-287-8159
Practice Address - Street 1:2302 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1221
Practice Address - Country:US
Practice Address - Phone:765-939-2020
Practice Address - Fax:765-939-0488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200022960KMedicaid
IN200022960KMedicaid