Provider Demographics
NPI:1083037022
Name:AMEDCO INDIANA LLC
Entity Type:Organization
Organization Name:AMEDCO INDIANA LLC
Other - Org Name:WABASH VALLEY EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-881-0022
Mailing Address - Street 1:2020 S CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-5576
Mailing Address - Country:US
Mailing Address - Phone:812-882-9600
Mailing Address - Fax:
Practice Address - Street 1:2020 S CLEARVIEW DR
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-5576
Practice Address - Country:US
Practice Address - Phone:812-882-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty