Provider Demographics
NPI:1174734172
Name:LAKEVIEW EYE PHYSICIANS, P.C.
Entity type:Organization
Organization Name:LAKEVIEW EYE PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:REEDER
Authorized Official - Last Name:WESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-773-5153
Mailing Address - Street 1:18051 RIVER AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-7093
Mailing Address - Country:US
Mailing Address - Phone:317-773-5153
Mailing Address - Fax:317-773-6452
Practice Address - Street 1:18051 RIVER AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-7093
Practice Address - Country:US
Practice Address - Phone:317-773-5153
Practice Address - Fax:317-773-6452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50001314A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
311600Medicare ID - Type Unspecified