Basic Information
| Provider Information | |||||||||
| NPI: | 1992830319 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALLISONVILLE EYE CARE CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10967 ALLISONVILLE RD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | FISHERS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460382632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175770707 | ||||||||
| FaxNumber: | 3175771567 | ||||||||
| Practice Location | |||||||||
| Address1: | 10967 ALLISONVILLE RD | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | FISHERS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460382632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175770707 | ||||||||
| FaxNumber: | 3175771567 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 01/21/2010 | ||||||||
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| AuthorizedOfficialLastName: | ROARK | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3175770707 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 18002130A | IN | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.