Active NPI
Eye Physicians Inc
- Ophthalmology Physician
- Kokomo, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 50000605A
- Legal business name
- EYE PHYSICIANS INC
- Practice address
- 3433 S Lafountain St
Kokomo, IN 46902-3801 - Phone
- (765) 453-3777
- Fax
- (765) 453-6577
- NPI assigned
- Nov 29, 2006
- Last updated
- Jan 28, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Michael R Wild, MD
- Title
- Owner
- Phone
- (765) 453-3777
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 50000605A | IN | Primary |
Addresses
Primary practice location
3433 S Lafountain St
Kokomo, IN 46902-3801
Mailing address
3433 S Lafountain St
Kokomo, IN 46902-3801
Phone (765) 453-3777
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100136020A | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050505000278 | IN | Part B Supplier - Clinic/Group Practice | 4385684711 |
Receives reassigned benefits from 4 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Logansport, IN; Kokomo, IN |
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D2053103 | Eye Physicians, Inc | Certificate of waiver | Jan 24, 2027 |
National Provider Directory
National Provider DirectoryLocations
333 Mall Rd
Logansport, IN 46947
Phone (574) 722-1797
Practitioners & affiliated clinicians
Practitioners 5
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.
-
- Ophthalmology Physician
- Kokomo, IN
- NPI 1437110541
-
- Ophthalmology Physician
- Marion, IN
- NPI 1043292337
-
- Ophthalmology Physician
- Indianapollis, IN
- NPI 1255391686
-
- Ophthalmology Physician
- Kokomo, IN
- NPI 1376699348
-
- Ophthalmology Physician
- Logansport, IN
- NPI 1528047784
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1580169600000",
"number": "1972670982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3433 S LAFOUNTAIN ST",
"city": "KOKOMO",
"state": "IN",
"postal_code": "469023801",
"telephone_number": "765-453-3777",
"fax_number": "765-453-6577"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3433 S LAFOUNTAIN ST",
"city": "KOKOMO",
"state": "IN",
"postal_code": "469023801",
"telephone_number": "765-453-3777",
"fax_number": "765-453-6577"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EYE PHYSICIANS INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-29",
"last_updated": "2020-01-28",
"certification_date": "2020-01-28",
"status": "A",
"authorized_official_last_name": "WILD",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "765-453-3777",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "IN",
"license": "50000605A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100136020A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Kokomo, IN
- Andre Ewing
- Dewayne M. Ewing, DPT
- Leah Exmeyer, RBT
- Eye Center Group LLC (Kokomo Eye Center)
- Eye Center Group LLC (Kokomo Eye Center)
- Eye Specialists of East Central Indiana, LLC (Kokomo Eye Specialists)
- Eyecare Indiana II, PC (C&B Optical One)
- Eyecare Indiana LL, PC (C&B Optical One)
- Tara L Eytcheson
- Facial Plastic Surgery Ears, Nose, and Throat Clinic
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2020; 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.