Eye Doctors of Michiana

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

01061571A Issued in IN

Legal business name

EYE DOCTORS OF MICHIANA

Practice address

10360 S Cedar Lake Dr
Granger, IN 46530-5835

Phone

(574) 674-6803

NPI assigned

Feb 3, 2011

Last updated

Feb 3, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

John S Kim, MD

Title

President

Phone

(574) 674-6803

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1296691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296691200000",
    "number": "1174829493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10360 S CEDAR LAKE DR",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465305835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10360 S CEDAR LAKE DR",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465305835",
            "telephone_number": "574-674-6803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE DOCTORS OF MICHIANA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-03",
        "last_updated": "2011-02-03",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "574-674-6803",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IN",
            "license": "01061571A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000000521575",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00442912",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Hurst Nutrition and Wellness
• Laura Eshowsky, PT
• Scott Michael Eshowsky, M.D.
• Amy Estes, PT, DPT, CFNIP
• Miriam Senge Ewang, PHARMD
• Eyecare Indiana II, PC (C&B Optical One)
• Eyecare Indiana LL, PC (C&B Optical One)
• Eyemart Express LLC
• Eyemart Express, LTD.
• Adaora Ezenekwe, PHARMACIST

• Ophthalmology Physician in Granger, IN
• Providers in Granger, IN by specialty
• Ophthalmology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2011; 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.