Healthcare Provider Details

I. General information

NPI: 1174154967
Provider Name (Legal Business Name): WHITEWATER EYE CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1049 STATE ROAD 229
BATESVILLE IN
47006-6808
US

IV. Provider business mailing address

1900 CHESTER BLVD
RICHMOND IN
47374-1213
US

V. Phone/Fax

Practice location:
  • Phone: 866-788-0001
  • Fax:
Mailing address:
  • Phone: 765-962-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: KEVIN T SCRIPTURE
Title or Position: PART OWNER
Credential: MD
Phone: 765-962-2020