Healthcare Provider Details

I. General information

NPI: 1932215373
Provider Name (Legal Business Name): EYE CENTER GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N TILLOTSON AVE
MUNCIE IN
47304-3988
US

IV. Provider business mailing address

200 N TILLOTSON AVE
MUNCIE IN
47304-3988
US

V. Phone/Fax

Practice location:
  • Phone: 765-286-8888
  • Fax: 765-747-7962
Mailing address:
  • Phone: 765-286-8888
  • Fax: 765-747-7962

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: DR. JEFFREY S RAPKIN
Title or Position: PART OWNER
Credential: MD
Phone: 765-286-8888