=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821170499
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYE CARE SURGERY CENTER OF EVANSVILLE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2006
-----------------------------------------------------
Last Update Date | 09/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6540 LOGAN DRIVE SUITE 3
-----------------------------------------------------
City | EVANSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47715-8238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-402-9620
-----------------------------------------------------
Fax | 812-402-9277
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6540 LOGAN DRIVE SUITE 3
-----------------------------------------------------
City | EVANSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47715-8238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-402-9620
-----------------------------------------------------
Fax | 812-402-9277
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. DAVID IRWIN MALITZ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 812-421-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 08-004274-1
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------