Provider Demographics
NPI:1568663003
Name:LLOYD R. TAUSTINE PC
Entity Type:Organization
Organization Name:LLOYD R. TAUSTINE PC
Other - Org Name:TAUSTINE EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAUSTINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-265-6535
Mailing Address - Street 1:601 BROADWAY ST STE 10
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-3364
Mailing Address - Country:US
Mailing Address - Phone:812-265-6535
Mailing Address - Fax:812-265-6212
Practice Address - Street 1:601 BROADWAY ST STE 10
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-3364
Practice Address - Country:US
Practice Address - Phone:812-265-6535
Practice Address - Fax:812-265-6212
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LLOYD R TAUSTINE PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-31
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100148660AMedicaid
IN100148660AMedicaid
IN=========OtherTAX ID