Provider Demographics
NPI:1518416692
Name:NORMAN EYECARE LTD
Entity Type:Organization
Organization Name:NORMAN EYECARE LTD
Other - Org Name:NORMAN & MILLER EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:KEYSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-564-2800
Mailing Address - Street 1:408 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1600
Mailing Address - Country:US
Mailing Address - Phone:765-362-4893
Mailing Address - Fax:
Practice Address - Street 1:408 W MARKET ST
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1600
Practice Address - Country:US
Practice Address - Phone:765-362-4893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002026152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100462000EMedicaid
IN100462000EMedicaid