Basic Information
| Provider Information | |||||||||
| NPI: | 1245300060 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALOGH | ||||||||
| FirstName: | MIKLOS | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1123 STOMMEL PL | ||||||||
| Address2: | UNIT #2 | ||||||||
| City: | DYER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463111658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7732977602 | ||||||||
| FaxNumber: | 7736851607 | ||||||||
| Practice Location | |||||||||
| Address1: | 279 W 80TH PL | ||||||||
| Address2: | |||||||||
| City: | MERRILLVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464105491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197382180 | ||||||||
| FaxNumber: | 2197382847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 04/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046-008297 | IL | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 18003388A | IN | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.