Healthcare Provider Details

I. General information

NPI: 1689621252
Provider Name (Legal Business Name): ORANGE COUNTY EYE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 W HOSPITAL RD
PAOLI IN
47454-8807
US

IV. Provider business mailing address

488 W HOSPITAL RD
PAOLI IN
47454-8807
US

V. Phone/Fax

Practice location:
  • Phone: 812-723-4752
  • Fax: 812-723-4753
Mailing address:
  • Phone: 812-723-4752
  • Fax: 812-723-4753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18001845A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC MARSHALL HARMON
Title or Position: MANAGER
Credential: O.D.
Phone: 812-723-4752