Provider Demographics
NPI:1083942536
Name:RM VISION PC
Entity Type:Organization
Organization Name:RM VISION PC
Other - Org Name:EAST OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD, PHD
Authorized Official - Phone:765-653-8245
Mailing Address - Street 1:901 EVENSVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-1105
Mailing Address - Country:US
Mailing Address - Phone:765-653-8245
Mailing Address - Fax:765-653-5009
Practice Address - Street 1:2399 S STATE ROAD 46
Practice Address - Street 2:WALMART VISION CENTER #4235
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803-9306
Practice Address - Country:US
Practice Address - Phone:812-872-2537
Practice Address - Fax:812-872-2539
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RM VISION PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003118A152W00000X, 152WC0802X
IN18001975A152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty