Provider Demographics
NPI:1871588442
Name:20/20 EYE PHYSICIANS OF INDIANA P C
Entity type:Organization
Organization Name:20/20 EYE PHYSICIANS OF INDIANA P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:IRELAND
Authorized Official - Suffix:
Authorized Official - Credentials:COA
Authorized Official - Phone:317-871-5900
Mailing Address - Street 1:8220 NAAB RD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1933
Mailing Address - Country:US
Mailing Address - Phone:317-871-5900
Mailing Address - Fax:317-872-6439
Practice Address - Street 1:2020 W 86TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1969
Practice Address - Country:US
Practice Address - Phone:317-871-5900
Practice Address - Fax:317-872-6439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100062220Medicaid
INCB2286OtherRAILROAD MEDICARE
INCB2286OtherRAILROAD MEDICARE
IN100062220Medicaid