Healthcare Provider Details

I. General information

NPI: 1336219922
Provider Name (Legal Business Name): EYE ASSOCIATES OF SOUTHERN INDIANA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 04/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W 14TH ST #100
JEFFERSONVILLE IN
47130
US

IV. Provider business mailing address

302 W 14TH ST #100
JEFFERSONVILLE IN
47130
US

V. Phone/Fax

Practice location:
  • Phone: 812-284-0660
  • Fax: 812-284-3822
Mailing address:
  • Phone: 812-284-0660
  • Fax: 812-284-3822

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: MS. RONDA L BOMAN
Title or Position: INS SUPERVISOR
Credential:
Phone: 812-258-4510