Provider Demographics
NPI:1689489759
Name:GLENDALE FAMILY EYE CARE, LLC
Entity type:Organization
Organization Name:GLENDALE FAMILY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-737-4293
Mailing Address - Street 1:PO BOX 1024
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46082-1024
Mailing Address - Country:US
Mailing Address - Phone:317-737-4293
Mailing Address - Fax:
Practice Address - Street 1:6101 N KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2488
Practice Address - Country:US
Practice Address - Phone:317-737-4293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-07
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty