Provider Demographics
NPI:1053990531
Name:HOMETOWN OPHTHALMOLOGY LLC
Entity type:Organization
Organization Name:HOMETOWN OPHTHALMOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:G
Authorized Official - Last Name:PRIMUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-400-3814
Mailing Address - Street 1:641 S HEBRON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-4048
Mailing Address - Country:US
Mailing Address - Phone:812-616-2020
Mailing Address - Fax:812-616-1400
Practice Address - Street 1:641 S HEBRON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-4048
Practice Address - Country:US
Practice Address - Phone:812-616-2020
Practice Address - Fax:812-616-1400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-03
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1114292208OtherNPI