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General NPI Number Information
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NPI Number | 1205023363
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Entity Type | Organization
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Legal Business Name | EYE ASSOCIATES OF SOUTHERN INDIANA PC
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Dates
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Enumeration Date | 10/02/2007
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Last Update Date | 02/20/2013
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Provider Practice Location Address
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Address Line | 1350 S JACKSON STREET
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City | SALEM
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State | IN
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Zip | 47167-7218
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Country | US
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Telephone | 812-896-1717
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 S JACKSON ST
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City | SALEM
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State | IN
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Zip | 47167-9190
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Country | US
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Telephone | 812-896-1717
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRADLEY BLACK
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Credential | MD
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Telephone | 812-284-0660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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