Organization
LAFAYETTE RETINA CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY E SCHRAUT MD (OWNER)
(765) 446-9446
Entity
Organization
Contact information
Practice address
100 PROFESSIONAL CT, SUITE 101, LAFAYETTE, IN 47905-5161
(765) 446-9446
(765) 447-9672
Mailing address
100 PROFESSIONAL CT, SUITE 101, LAFAYETTE, IN 47905-5161
(765) 446-9446
(765) 447-9672
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01042571
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1C18940
LEGACY
IN
Enumeration date
02/14/2008
Last updated
02/14/2008
Update your record
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