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General NPI Number Information
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NPI Number | 1700049533
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Entity Type | Organization
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Legal Business Name | NEWBURGH EYE CARE, P.C.
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 8688 RUFFIAN LN SUITE B
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City | NEWBURGH
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State | IN
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Zip | 47630-3411
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Country | US
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Telephone | 812-853-8191
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Fax |
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Provider Business Mailing Address
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Address Line | 8688 RUFFIAN LN SUITE B
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City | NEWBURGH
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State | IN
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Zip | 47630-3411
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Country | US
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Telephone | 812-853-8191
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JOHN A GILLES
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Credential | O.D.
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Telephone | 812-853-8191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | 18002239
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License Number State | IN
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