Healthcare Provider Details

I. General information

NPI: 1285012435
Provider Name (Legal Business Name): EYE ASSOCIATES OF SOUTHERN INDIANA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 SPRING ST SUITE 1
JEFFERSONVILLE IN
47130-3748
US

IV. Provider business mailing address

1407 SPRING ST SUITE 1
JEFFERSONVILLE IN
47130-3748
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 TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: RONDA BOMAN
Title or Position: INSURANCE DIRECTOR
Credential:
Phone: 812-590-6157