Healthcare Provider Details

I. General information

NPI: 1992737324
Provider Name (Legal Business Name): EYECARE ASSOCIATES OF MICHIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8984 E US HIGHWAY 20
NEW CARLISLE IN
46552-9038
US

IV. Provider business mailing address

8984 E US HIGHWAY 20
NEW CARLISLE IN
46552-9038
US

V. Phone/Fax

Practice location:
  • Phone: 574-654-8806
  • Fax: 574-654-7257
Mailing address:
  • Phone: 574-654-8806
  • Fax: 574-654-7257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18001874
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002590
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002128
License Number StateIN

VIII. Authorized Official

Name: DR. TOM L MORTON
Title or Position: PARTNER/OD
Credential: OD
Phone: 574-654-8806