Healthcare Provider Details

I. General information

NPI: 1962533851
Provider Name (Legal Business Name): EYE ASSOCIATES OF SOUTHERN INDIANA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 COMANCHE TRAIL
FRANKFORT KY
40601-1753
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 502-227-4508
  • Fax: 502-226-3315
Mailing address:
  • Phone: 812-280-2162
  • Fax: 812-284-3822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1520DT
License Number StateKY

VIII. Authorized Official

Name: KRISTOPHER PUGH
Title or Position: OWNER MD
Credential: MD
Phone: 812-284-0660