NPIMap

Organization Active NPI

Phillip G Koultourides, O.D. P.C.

Doing business as Schererville Eyecare & Contact Lens Clinic

  • Optometrist
  • Schererville, IN
National Provider Identifier
1316567134
Registry record updated Apr 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
PHILLIP G KOULTOURIDES, O.D. P.C.
Doing business as
Schererville Eyecare & Contact Lens Clinic
Practice address
210 Indianapolis Blvd
Suite B
Schererville, IN 46375
Phone
(219) 322-3819
NPI assigned
Apr 22, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2020

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

Authorized official

Name
Phillip KoultouridesNPI 1295847986
Title
President
Phone
(219) 670-6589

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

210 Indianapolis Blvd
Suite B
Schererville, IN 46375

Mailing address

9140 Drake Dr
Saint John, IN 46373
Phone (219) 670-6589

Other practice location 1

2407 Northland Dr
Valparaiso, IN 46383
Phone (219) 465-2788

Other names 1

  • Schererville Eyecare & Contact Lens Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Phillip G Koultourides OD PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1587513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587513600000",
    "number": "1316567134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9140 DRAKE DR",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "46373",
            "telephone_number": "219-670-6589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 INDIANAPOLIS BLVD",
            "address_2": "SUITE B",
            "city": "SCHERERVILLE",
            "state": "IN",
            "postal_code": "46375",
            "telephone_number": "219-322-3819"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2407 Northland Dr",
            "address_purpose": "LOCATION",
            "city": "Valparaiso",
            "state": "IN",
            "postal_code": "46383",
            "country_code": "US",
            "telephone_number": "219-465-2788",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHILLIP G KOULTOURIDES, O.D. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-22",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A",
        "authorized_official_last_name": "KOULTOURIDES",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-670-6589"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Schererville Eyecare & Contact Lens Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Schererville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2020; 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.