Provider Demographics
NPI:1689610305
Name:EYECARE ASSOCIATES OF MICHIANA, LLC
Entity Type:Organization
Organization Name:EYECARE ASSOCIATES OF MICHIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OD
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:L
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:574-287-0890
Mailing Address - Street 1:17477 GENERATIONS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635
Mailing Address - Country:US
Mailing Address - Phone:574-287-0890
Mailing Address - Fax:574-287-0899
Practice Address - Street 1:17477 GENERATIONS DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1584
Practice Address - Country:US
Practice Address - Phone:574-287-0890
Practice Address - Fax:574-287-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002128152W00000X
IN18002590152W00000X
IN18001874152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU34052Medicare UPIN
IN162110Medicare ID - Type Unspecified
INT35013Medicare UPIN
INT34599Medicare UPIN
IN145630Medicare ID - Type Unspecified
IN736590Medicare ID - Type Unspecified