Provider Demographics
NPI:1497879712
Name:VINCENNES OCULAR CENTRE, INC.
Entity Type:Organization
Organization Name:VINCENNES OCULAR CENTRE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-886-4411
Mailing Address - Street 1:414 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-2020
Mailing Address - Country:US
Mailing Address - Phone:812-886-4411
Mailing Address - Fax:
Practice Address - Street 1:414 MAIN ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-2020
Practice Address - Country:US
Practice Address - Phone:812-886-4411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0555400001Medicare NSC