Organization
MICHIANA EYE CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN R BAXTER DO (OWNER/OPHTHALMOLOGIST)
(574) 271-3939
Entity
Organization
Contact information
Practice address
319 N NILES AVE # 100, SOUTH BEND, IN 46617
(574) 282-2020
(574) 288-2020
Mailing address
230 E DAY RD STE 100, MISHAWAKA, IN 46545-3408
(574) 271-3939
(574) 271-3941
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
174400000X
Specialist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100092980
—
IN
01
—
204460
MEDICARE PTAN
IN
01
—
DA1131
RAILROAD MEDICARE
IN
Enumeration date
12/05/2006
Last updated
06/18/2018
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