Organization
EYE DOCTORS OF MICHIANA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN S KIM MD (PRESIDENT)
(574) 674-6803
Entity
Organization
Contact information
Practice address
10360 S CEDAR LAKE DR, GRANGER, IN 46530-5835
(574) 674-6803
Mailing address
10360 S CEDAR LAKE DR, GRANGER, IN 46530-5835
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01061571A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000521575
BLUE CROSS
IN
01
—
P00442912
RAILROAD MEDICARE
—
Enumeration date
02/03/2011
Last updated
02/03/2011
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