Healthcare Provider Details

I. General information

NPI: 1447259510
Provider Name (Legal Business Name): JOHN KENYON AMERICAN EYE INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 STATE ST
NEW ALBANY IN
47150-3620
US

IV. Provider business mailing address

519 STATE ST
NEW ALBANY IN
47150-3620
US

V. Phone/Fax

Practice location:
  • Phone: 812-948-0616
  • Fax: 812-949-3446
Mailing address:
  • Phone: 812-948-0616
  • Fax: 812-949-3447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: JOSEPH P. GIRA
Title or Position: OWNER/MANAGER
Credential: MD
Phone: 812-258-3048