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General NPI Number Information
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NPI Number | 1639379878
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Entity Type | Organization
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Legal Business Name | GIBSON COUNTY EYECARE INC
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 516 N MAIN ST
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City | PRINCETON
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State | IN
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Zip | 47670-1406
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Country | US
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Telephone | 812-385-4857
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Fax | 812-386-5770
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Provider Business Mailing Address
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Address Line | 516 N MAIN ST
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City | PRINCETON
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State | IN
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Zip | 47670-1406
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Country | US
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Telephone | 812-385-4857
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Fax | 812-386-5770
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. JESSICA RENAE MCELLHINEY
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Credential | OD
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Telephone | 812-385-4857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18002082A
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License Number State | IN
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