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Organization

MICHIANA EYE CENTER , LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KEVIN R BAXTER DO (OWNER/OPHTHALMOLOGISTS)
(574) 271-3939
Entity
Organization

Contact information

Practice address
2216 CASSOPOLIS ST, ELKHART, IN 46514
(574) 266-2111
(574) 266-0555
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
DA1128
RR MEDICARE
IN
Enumeration date
05/25/2011
Last updated
06/18/2018
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