NPIMap

Organization Active NPI

Midwest Eye Consultants, P.C.

Doing business as Midwest Eye Consultants #43

  • Optometrist
  • Shipshewana, IN
National Provider Identifier
1952607780
Registry record updated Jun 20, 2013
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 #43
Practice address
350 S Van Buren St
Suite 2B
Shipshewana, IN 46565-9197
Phone
(260) 768-7721
Fax
(260) 768-7747
NPI assigned
Jan 26, 2011
Last updated
Jun 20, 2013By 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 Jun 20, 2013

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

Authorized official

Name
Dr. Gregory L Garner, O.D.NPI 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

350 S Van Buren St
Suite 2B
Shipshewana, IN 46565-9197

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
100082470WMedicaidIN

Other names 1

  • Midwest Eye Consultants #43 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
O20110616000395 IN DME Supplier - Physician - Optometrist 2961399217 Practice locations: Shipshewana, 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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
15D2147581Midwest Eye Consultants #43350 S Van Buren Suite D, Shipshewana, IN 46565Certificate of waiverApr 22, 2028

National Provider Directory

National Provider Directory
Part of
Midwest Eye Consultants 34

Locations

805 High St
Decatur, IN 46733
Phone (219) 563-3672

1513 S State Road 37
Elwood, IN 46036
Phone (765) 552-5515

726 N Broadway
Peru, IN 46970
Phone (317) 473-3211

Practitioners & affiliated clinicians

Practitioners 7

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": "1296000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371686400000",
    "number": "1952607780",
    "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": "350 S VAN BUREN ST",
            "address_2": "SUITE 2B",
            "city": "SHIPSHEWANA",
            "state": "IN",
            "postal_code": "465659197",
            "telephone_number": "260-768-7721",
            "fax_number": "260-768-7747"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST EYE CONSULTANTS, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIDWEST EYE CONSULTANTS, P.C.",
        "enumeration_date": "2011-01-26",
        "last_updated": "2013-06-20",
        "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_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "56000164A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100082470W",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midwest Eye Consultants #43",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shipshewana, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2013; 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.