Midwest Eye Consultants, P.C.
Organization Active NPI Optometrist · Berne, IN
NPI 1578090239 · NPPES record last updated Jan 17, 2018
Key facts
- NPI
- 1578090239
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 56000164A (IN)
- Legal business name
- MIDWEST EYE CONSULTANTS, P.C.
- Practice address
- 150 Forest Park Dr
Berne, IN 46711-1745 - Phone
- (260) 569-9550
- Fax
- (260) 569-0760
- NPI assigned
- May 12, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- MIDWEST EYE CONSULTANTS, P.C.
Authorized official
- Name
- Gregory L Garner, OD
- Title
- President
- Phone
- (260) 569-9550
Practitioners 1
-
Randy Fortkamp, OD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D2147609 | Midwest Eye Consultants #50 | Certificate of waiver | Apr 22, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040302000158 | IN | Part B Supplier - Clinic/Group Practice | 2961399217 |
Receives reassigned benefits from 100 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Part of
- Garner Trump Eye Care
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 56000164A | IN | Yes |
Addresses
Primary practice location
150 Forest Park Dr
Berne, IN 46711-1745
Mailing address
PO Box 549
Wabash, IN 46992-0549
Phone (260) 569-9550
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300007413 | Medicaid | IN |
Other names
- Midwest Eye Consultants #50
Other providers in Berne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.