Basic Information
| Provider Information | |||||||||
| NPI: | 1396143517 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OSSIP OPTOMETRY, PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OSSIP OPTOMETRY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9795 CROSSPOINT BLVD | ||||||||
| Address2: | STE 100 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462563354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172546480 | ||||||||
| FaxNumber: | 3172598609 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 PROFESSIONAL CT | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479055152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654475083 | ||||||||
| FaxNumber: | 7654484716 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2014 | ||||||||
| LastUpdateDate: | 10/28/2015 | ||||||||
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| AuthorizedOfficialLastName: | DABELOW | ||||||||
| AuthorizedOfficialFirstName: | RYAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF INSURANCE AND FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 3172546480 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OSSIP OPTOMETRY, PC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 18003424A | IN | Y | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.