Provider Demographics
NPI:1366274235
Name:CITY OPTICAL CO., INC.
Entity type:Organization
Organization Name:CITY OPTICAL CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-924-1300
Mailing Address - Street 1:2839 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-2147
Mailing Address - Country:US
Mailing Address - Phone:317-924-1300
Mailing Address - Fax:
Practice Address - Street 1:12676 E 116TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7602
Practice Address - Country:US
Practice Address - Phone:317-924-1300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OPTICAL CO., INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty