Organization
PRIVIA MEDICAL GROUP INDIANA, LLC
Active
Other names
Elkhart Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS VANDERGRIFT (CEO)
(574) 296-3200
Entity
Organization
Contact information
Practice address
2222 W LEXINGTON AVE, ELKHART, IN 46514-1420
(574) 294-3030
(574) 296-3544
Mailing address
PO BOX 2968, ELKHART, IN 46515-2968
(574) 296-3200
(574) 296-3392
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Enumeration date
11/05/2015
Last updated
05/12/2025
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