Basic Information
| Provider Information | |||||||||
| NPI: | 1558567073 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HENDRICKS COUNTY HOSPITAL | ||||||||
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| OtherOrganizationName: | AVON OPHTHALMOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 SOUTHFIELD DRIVE | ||||||||
| Address2: | SUITE 1370 | ||||||||
| City: | PLAINFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461684300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178375571 | ||||||||
| FaxNumber: | 3178375580 | ||||||||
| Practice Location | |||||||||
| Address1: | 8244 E US HIGHWAY 36 | ||||||||
| Address2: | SUITE 1270 | ||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461239621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172724242 | ||||||||
| FaxNumber: | 3172726640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 06/11/2013 | ||||||||
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| AuthorizedOfficialLastName: | KLAYER | ||||||||
| AuthorizedOfficialFirstName: | GENI | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3178375571 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HENDRICKS COUNTY HOSPITAL | ||||||||
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| AuthorizedOfficialCredential: | RN, BSN, MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.