Provider Demographics
NPI:1609840925
Name:BRIGGS OPHTHALMOLOGY & ASSOCIATES, S.C.
Entity type:Organization
Organization Name:BRIGGS OPHTHALMOLOGY & ASSOCIATES, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-322-2723
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-0234
Mailing Address - Country:US
Mailing Address - Phone:219-322-2723
Mailing Address - Fax:219-864-9707
Practice Address - Street 1:1467 JOLIET ST STE C
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-2073
Practice Address - Country:US
Practice Address - Phone:219-322-2723
Practice Address - Fax:219-864-9707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001151A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INE40149Medicare UPIN
IN215780BMedicare ID - Type Unspecified