Provider Demographics
NPI:1659553956
Name:EYE CENTER GROUP LLC
Entity Type:Organization
Organization Name:EYE CENTER GROUP LLC
Other - Org Name:RICHMOND EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-983-2115
Mailing Address - Street 1:1900 CHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1213
Mailing Address - Country:US
Mailing Address - Phone:765-966-1945
Mailing Address - Fax:765-966-2975
Practice Address - Street 1:1900 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1213
Practice Address - Country:US
Practice Address - Phone:765-966-1945
Practice Address - Fax:765-966-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN905780Medicare PIN