Healthcare Provider Details
I. General information
NPI: 1124037163
Provider Name (Legal Business Name): THE EYE CENTER GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 08/07/2006
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
882 E GREENVILLE AVE
WINCHESTER IN
47394-8441
US
IV. Provider business mailing address
882 E GREENVILLE AVE
WINCHESTER IN
47394-8441
US
V. Phone/Fax
- Phone: 765-584-1320
- Fax: 765-584-2317
- Phone: 765-584-1320
- Fax: 765-584-2317
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 332B00000X |
| Taxonomy | Durable Medical Equipment & Medical Supplies |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
JEFFREY
S
RAPKIN
Title or Position: PART OWNER
Credential: MD
Phone: 765-286-8888