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General NPI Number Information
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NPI Number | 1710098389
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Entity Type | Organization
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Legal Business Name | EYECARE SPECIALISTS
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 325 W NATIONAL AVE
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City | BRAZIL
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State | IN
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Zip | 47834-2542
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Country | US
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Telephone | 812-443-0060
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Fax | 812-446-5061
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Provider Business Mailing Address
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Address Line | 325 W NATIONAL AVE
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City | BRAZIL
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State | IN
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Zip | 47834-2542
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Country | US
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Telephone | 812-443-0060
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Fax | 812-446-5061
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DARLA HECK SACOPULOS
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Credential | O.D.
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Telephone | 812-443-0060
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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 | 18002508A
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License Number State | IN
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