NPIMap

Organization Active NPI

Midwest Eye Consultants, P.C.

Doing business as Midwest Eye Consultants DuPont

  • Optometrist
  • Fort Wayne, IN
National Provider Identifier
1649654526
Registry record updated Apr 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
56000164A Issued in IN
Legal business name
MIDWEST EYE CONSULTANTS, P.C.
Doing business as
Midwest Eye Consultants DuPont
Practice address
2874 E Dupont Rd
Fort Wayne, IN 46825-1669
Phone
(260) 490-1631
NPI assigned
Jul 10, 2015
Last updated
Apr 18, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
MIDWEST EYE CONSULTANTS, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 18, 2016

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

Authorized official

Name
Gregory L Garner, ODNPI 1639139801
Title
Pres/Ceo
Phone
(260) 569-9550

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 56000164A IN Primary

Addresses

Primary practice location

2874 E Dupont Rd
Fort Wayne, IN 46825-1669

Mailing address

PO Box 549
Wabash, IN 46992-0549
Phone (260) 569-9550

Other identifiers 1

IdentifierTypeStateIssuer
201084240AMedicaidIN

Other names 1

  • Midwest Eye Consultants DuPont Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040302000158 IN Part B Supplier - Clinic/Group Practice 2961399217 Receives reassigned benefits from 100 practitioners
This NPI is an additional NPI on the enrollment
O20150924001802 IN DME Supplier - Physician - Optometrist 2961399217 Practice locations: Fort Wayne, IN

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Midwest Eye Consultants Dupont2874E Dupont Rd, Fort Wayne, IN 46825-1669(260) 490-1631 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jun 1, 1996

National Provider Directory

National Provider Directory
Tax ID family
Midwest Eye Consultants 3428 organizations share this tax ID, including this one
Part of
Midwest Eye Consultants 34

Other organizations with this tax ID 27

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

View all 27

Locations

750 N Grandstaff Dr
Auburn, IN 46706
Phone (260) 925-3116

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1436486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460937600000",
    "number": "1649654526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 549",
            "city": "WABASH",
            "state": "IN",
            "postal_code": "469920549",
            "telephone_number": "260-569-9550",
            "fax_number": "260-569-0760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2874 E DUPONT RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251669",
            "telephone_number": "260-490-1631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST EYE CONSULTANTS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIDWEST EYE CONSULTANTS, P.C.",
        "enumeration_date": "2015-07-10",
        "last_updated": "2016-04-18",
        "status": "A",
        "authorized_official_last_name": "GARNER",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRES/CEO",
        "authorized_official_telephone_number": "260-569-9550",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "56000164A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201084240A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Eye Consultants DuPont",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.