Healthcare Provider Details

I. General information

NPI: 1477972487
Provider Name (Legal Business Name): PRECISION FAMILY EYE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 LAFOLLETTE STA S
FLOYDS KNOBS IN
47119-9780
US

IV. Provider business mailing address

409 LAFOLLETTE STA S
FLOYDS KNOBS IN
47119-9780
US

V. Phone/Fax

Practice location:
  • Phone: 812-728-8163
  • Fax:
Mailing address:
  • Phone: 812-728-8163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003510A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. KEITH A ROBERTS
Title or Position: OWNER/OPTOMETRIST
Credential: O.D.
Phone: 812-399-2777