MEDICARE: EYE ASSOCIATES GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WL0500X	Low Vision Rehabilitation Optometrist
2	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CA7728	OTHER	IN	RRMC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649324831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE ASSOCIATES GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 166
Second Line	:
City	:	HARTFORD CITY
State	:	IN
Zip	:	47348-0166
Country	:	US
Telephone Number	:	765-348-2020
Fax Number	:	765-348-2503

Provider Business Practice Location Address
First Line	:	315 HUGGINS DR
Second Line	:
City	:	HARTFORD CITY
State	:	IN
Zip	:	47348-8999
Country	:	US
Telephone Number	:	765-348-2020
Fax Number	:	765-348-2503

Authorized Official
Title or Position	:	ACCOUNTS MANAGER
Name	:	MRS. SHELLEY A. TEAGLE
Credential	:
Telephone Number	:	765-348-2020

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	11/19/2010

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Directions to “EYE ASSOCIATES GROUP, LLC ” Practice Location

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