Healthcare Provider Details

I. General information

NPI: 1649324831
Provider Name (Legal Business Name): EYE ASSOCIATES GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 HUGGINS DR
HARTFORD CITY IN
47348-8999
US

IV. Provider business mailing address

PO BOX 166
HARTFORD CITY IN
47348-0166
US

V. Phone/Fax

Practice location:
  • Phone: 765-348-2020
  • Fax: 765-348-2503
Mailing address:
  • Phone: 765-348-2020
  • Fax: 765-348-2503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHELLEY A. TEAGLE
Title or Position: ACCOUNTS MANAGER
Credential:
Phone: 765-348-2020