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General NPI Number Information
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NPI Number | 1871645689
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Entity Type | Organization
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Legal Business Name | OAKLAND CITY EYECARE, LLC
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 05/13/2011
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Provider Practice Location Address
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Address Line | 251 N MAIN ST
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City | OAKLAND CITY
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State | IN
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Zip | 47660-1329
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Country | US
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Telephone | 812-749-3700
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Fax |
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Provider Business Mailing Address
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Address Line | 251 N MAIN ST
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City | OAKLAND CITY
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State | IN
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Zip | 47660-1329
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY D. IRVIN
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Credential |
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Telephone | 812-749-3700
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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 |
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License Number State | IN
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