Provider Demographics
NPI:1366484180
Name:INDIAN SPRINGS EYE ASSOCIATES, PC
Entity Type:Organization
Organization Name:INDIAN SPRINGS EYE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EYE DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:S
Authorized Official - Last Name:HILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-465-6232
Mailing Address - Street 1:945 INDIAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3507
Mailing Address - Country:US
Mailing Address - Phone:724-465-6232
Mailing Address - Fax:724-465-0340
Practice Address - Street 1:945 INDIAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3507
Practice Address - Country:US
Practice Address - Phone:724-465-6232
Practice Address - Fax:724-465-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA125032Medicare PIN
PA410048643Medicare PIN
PA6230500001Medicare NSC