Provider Demographics
NPI:1760996623
Name:MICHIANA EYE INSTITUTE LLC
Entity type:Organization
Organization Name:MICHIANA EYE INSTITUTE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-220-0874
Mailing Address - Street 1:3809 N MAIN ST STE 100B
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3109
Mailing Address - Country:US
Mailing Address - Phone:574-520-1700
Mailing Address - Fax:833-989-0916
Practice Address - Street 1:3809 N MAIN ST STE 100B
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3109
Practice Address - Country:US
Practice Address - Phone:574-520-1700
Practice Address - Fax:833-989-0916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmologyGroup - Single Specialty