Healthcare Provider Details

I. General information

NPI: 1083037022
Provider Name (Legal Business Name): AMEDCO INDIANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 S CLEARVIEW DR
VINCENNES IN
47591-5576
US

IV. Provider business mailing address

2020 S CLEARVIEW DR
VINCENNES IN
47591-5576
US

V. Phone/Fax

Practice location:
  • Phone: 812-882-9600
  • Fax:
Mailing address:
  • Phone: 812-882-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ERICA PERREIRA
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 877-881-0022