Provider Demographics
NPI:1083908487
Name:INDIANA EYE CARE,INC
Entity Type:Organization
Organization Name:INDIANA EYE CARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINCEK BATESON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:723-349-8000
Mailing Address - Street 1:678 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3930
Mailing Address - Country:US
Mailing Address - Phone:724-349-8000
Mailing Address - Fax:724-357-9669
Practice Address - Street 1:678 PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3930
Practice Address - Country:US
Practice Address - Phone:724-349-8000
Practice Address - Fax:724-357-9669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001265152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty