Organization
POTTER FAMILY EYE CARE, LLC
Active
Other names
Potter Family Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUSTIN POTTER O.D. (OPTOMETRIST)
(317) 747-9263
Entity
Organization
Contact information
Practice address
5953 W BROADWAY, MC CORDSVILLE, IN 46055-9355
(317) 747-9263
(317) 747-9271
Mailing address
5953 W BROADWAY, MC CORDSVILLE, IN 46055-9355
(317) 747-9263
(317) 747-9271
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003358A
IN
332H00000X
Eyewear Supplier
18003358A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6592970001
MEDICARE DMEPOS PTAN
IN
01
—
M100047360
MEDICARE PTAN
IN
Enumeration date
12/01/2010
Last updated
04/23/2012
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