Organization
EYE PHYSICIANS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL R WILD MD (OWNER)
(765) 453-3777
Entity
Organization
Contact information
Practice address
333 MALL RD, LOGANSPORT, IN 46947-2279
(574) 722-1797
(574) 735-2827
Mailing address
3433 S LAFOUNTAIN ST, KOKOMO, IN 46902-3801
(765) 453-3777
(765) 453-6577
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
50000605A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100136020C
—
IN
Enumeration date
11/01/2006
Last updated
01/28/2020
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