Provider Demographics
NPI:1558523886
Name:PRECISION EYE GROUP P.C.
Entity Type:Organization
Organization Name:PRECISION EYE GROUP P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DECKARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-332-2020
Mailing Address - Street 1:322 S WOODSCREST DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5314
Mailing Address - Country:US
Mailing Address - Phone:812-332-2020
Mailing Address - Fax:812-334-1414
Practice Address - Street 1:3343 MICHAEL AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3535
Practice Address - Country:US
Practice Address - Phone:812-332-2020
Practice Address - Fax:812-334-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002304A152W00000X
IN18003450A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0347310001Medicare NSC