Provider Demographics
NPI:1053541755
Name:EYE ASSOCIATES OF SOUTHERN INDIANA PC
Entity type:Organization
Organization Name:EYE ASSOCIATES OF SOUTHERN INDIANA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-284-0660
Mailing Address - Street 1:302 W 14TH ST
Mailing Address - Street 2:STE 100A
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3751
Mailing Address - Country:US
Mailing Address - Phone:812-284-0660
Mailing Address - Fax:812-284-3822
Practice Address - Street 1:732 HIGH ST
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1234
Practice Address - Country:US
Practice Address - Phone:270-422-4241
Practice Address - Fax:812-284-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1155450005Medicare NSC