Healthcare Provider Details

I. General information

NPI: 1275958381
Provider Name (Legal Business Name): ATCHISON EYECARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2014
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 J ST
BEDFORD IN
47421-3839
US

IV. Provider business mailing address

1537 J ST
BEDFORD IN
47421-3839
US

V. Phone/Fax

Practice location:
  • Phone: 812-675-0890
  • Fax: 812-675-0891
Mailing address:
  • Phone: 812-675-0890
  • Fax: 812-675-0891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number18003679A
License Number StateIN

VIII. Authorized Official

Name: ALISON P ATCHISON
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 812-675-0890