Provider Demographics
NPI:1235637075
Name:MADISON EYE CENTER LLC
Entity Type:Organization
Organization Name:MADISON EYE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:502-883-1015
Mailing Address - Street 1:2932 BRECKENRIDGE LN STE 5
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1490
Mailing Address - Country:US
Mailing Address - Phone:502-371-9700
Mailing Address - Fax:502-540-3070
Practice Address - Street 1:601 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-3362
Practice Address - Country:US
Practice Address - Phone:502-883-1015
Practice Address - Fax:502-883-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X, 207WX0107X
IN02003914A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty