Healthcare Provider Details

I. General information

NPI: 1356332191
Provider Name (Legal Business Name): EYE CENTER GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 03/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 VIRGINIA AVE
CONNERSVILLE IN
47331-2921
US

IV. Provider business mailing address

PO BOX 457
RICHMOND IN
47375-0457
US

V. Phone/Fax

Practice location:
  • Phone: 765-825-0660
  • Fax: 765-825-3075
Mailing address:
  • Phone: 765-825-0660
  • Fax: 765-825-3075

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: DR. JEFFREY S RAPKIN
Title or Position: PART OWNER
Credential: M.D.
Phone: 765-286-8888