Stephen J. Massicotte, M.D., P.C.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

01039382A Issued in IN

Legal business name

STEPHEN J. MASSICOTTE, M.D., P.C.

Practice address

3955 Eagle Creek Pkwy
Suite C
Indianapolis, IN 46254-5615

Phone

(317) 280-8410

Fax

(317) 280-8414

NPI assigned

Feb 14, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Stephen John Massicotte, M.D.

Title

President

Phone

(317) 280-8410

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406332800000",
    "number": "1043353907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3955 EAGLE CREEK PKWY",
            "address_2": "SUITE C",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462545615",
            "telephone_number": "317-280-8410",
            "fax_number": "317-280-8414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3955 EAGLE CREEK PKWY",
            "address_2": "SUITE C",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462545615",
            "telephone_number": "317-280-8410",
            "fax_number": "317-280-8414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHEN J. MASSICOTTE, M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2014-07-26",
        "status": "A",
        "authorized_official_last_name": "MASSICOTTE",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "317-280-8410",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "IN",
            "license": "01039382A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100177550",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ophthalmology Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.