NPIMap

Organization Active NPI

Indiana Vision Clinic, Inc

  • Optometrist
  • South Bend, IN
National Provider Identifier
1497797047
Registry record updated Oct 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18001593B Issued in IN
Legal business name
INDIANA VISION CLINIC, INC
Practice address
2004 Edison Rd
Suite a
South Bend, IN 46617-1712
Phone
(574) 288-2400
Fax
(574) 288-7132
NPI assigned
Jun 11, 2006
Organization subpart
No

National Provider Directory

National Provider Directory

Locations

2004 Edison Rd
#A
South Bend, IN 46617
Phone (574) 288-2400

NPPES NPI Registry

Updated by the provider on Oct 21, 2010

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

Authorized official

Name
Dr. Ronald Milovich, OD
Title
Owner/Optometrist
Phone
(574) 288-2400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 18001593B IN Primary

Addresses

Primary practice location

2004 Edison Rd
Suite a
South Bend, IN 46617-1712

Mailing address

2004 Edison Rd
Suite a
South Bend, IN 46617-1712
Phone (574) 288-2400

Other identifiers 3

IdentifierTypeStateIssuer
000000273027OtherINBLUE CROSS BLUE SHIELD
200380990MedicaidIN
01171OtherINSPECTERA

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287619200000",
    "number": "1497797047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2004 EDISON RD",
            "address_2": "SUITE A",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171712",
            "telephone_number": "574-288-2400",
            "fax_number": "574-288-7132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2004 EDISON RD",
            "address_2": "SUITE A",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466171712",
            "telephone_number": "574-288-2400",
            "fax_number": "574-288-7132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA VISION CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2010-10-21",
        "status": "A",
        "authorized_official_last_name": "MILOVICH",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "574-288-2400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18001593B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000273027",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200380990",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "01171",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Bend, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2010; 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.