Organization
GREATER LAFAYETTE RETINA CENTER, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHYLLIS M. WATKINS (BILLING DEPARTMENT)
(765) 428-8888
Entity
Organization
Contact information
Practice address
1013 N 13TH ST, LAFAYETTE, IN 47904-2011
(765) 428-8888
(765) 428-8889
Mailing address
1013 N 13TH ST, LAFAYETTE, IN 47904-2011
(765) 428-8888
(765) 428-8889
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01057576A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01057576A
STATE LICENSE
IN
05
—
200441070
—
IN
01
—
POO176469
RAILROAD MEDICARE
IN
Enumeration date
05/03/2007
Last updated
06/27/2014
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