Healthcare Provider Details

I. General information

NPI: 1033383872
Provider Name (Legal Business Name): EYE ASSOCIATES OF SOUTHERN INDIANA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1356 N GARDNER ST
SCOTTSBURG IN
47170-7750
US

IV. Provider business mailing address

302 W 14TH ST SUITE 100A
JEFFERSONVILLE IN
47130-3751
US

V. Phone/Fax

Practice location:
  • Phone: 812-752-2020
  • Fax:
Mailing address:
  • Phone: 812-284-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18001655
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18001637
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18001510
License Number StateIN

VIII. Authorized Official

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