Healthcare Provider Details

I. General information

NPI: 1053990531
Provider Name (Legal Business Name): HOMETOWN OPHTHALMOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 S HEBRON AVE
EVANSVILLE IN
47714-4048
US

IV. Provider business mailing address

641 S HEBRON AVE
EVANSVILLE IN
47714-4048
US

V. Phone/Fax

Practice location:
  • Phone: 812-616-2020
  • Fax: 812-616-1400
Mailing address:
  • Phone: 812-616-2020
  • Fax: 812-616-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SALLY G PRIMUS
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 812-616-2020