Organization
LA PORTE CLINIC COMPANY LLC
Active
Other names
La Porte Physician Network Ophthalmology Care
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL A SWAW (DIRECTOR)
(615) 778-8076
Entity
Organization
Contact information
Practice address
1300 STATE ST, SUITE 1B, LA PORTE, IN 46350-3185
(219) 362-6297
(219) 324-3061
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
IN
156F00000X
Technician/Technologist
—
IN
207W00000X
Ophthalmology Physician
—
IN
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
IN
Other
Enumeration date
09/13/2016
Last updated
09/27/2016
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