Potter Family Eye Care, LLC
Organization Active NPI Optometrist · MC Cordsville, IN
NPI 1801198510 · NPPES record last updated Apr 23, 2012
Key facts
- NPI
- 1801198510
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 18003358A (IN)
- Legal business name
- POTTER FAMILY EYE CARE, LLC
- Practice address
- 5953 W Broadway
MC Cordsville, IN 46055-9355 - Phone
- (317) 747-9263
- Fax
- (317) 747-9271
- NPI assigned
- Dec 1, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. Austin Potter, O.D.
- Title
- Optometrist
- Phone
- (317) 747-9263
Practitioners 2
-
Elizabeth Marie Leburg, O.D.
-
Austin David Potter, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110610000062 | IN | Part B Supplier - Clinic/Group Practice | 1850578360 |
Receives reassigned benefits from 2 practitioners Practice locations: McCordsville, IN |
National Provider Directory
Locations
5937 W Broadway
McCordsville, IN 46055
Phone (317) 747-9263
5953 W Broadway
McCordsville, IN 46055
Phone (317) 747-9263
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 18003358A | IN | Yes |
| Eyewear Supplier | 332H00000X | 18003358A | IN |
Addresses
Primary practice location
5953 W Broadway
MC Cordsville, IN 46055-9355
Mailing address
5953 W Broadway
MC Cordsville, IN 46055-9355
Phone (317) 747-9263
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 6592970001 | Other | IN | MEDICARE DMEPOS PTAN |
| M100047360 | Other | IN | MEDICARE PTAN |
Other names
- Potter Family Eye Care
Other providers in MC Cordsville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 23, 2012. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.