Provider Demographics
NPI:1689621252
Name:ORANGE COUNTY EYE CARE, LLC
Entity Type:Organization
Organization Name:ORANGE COUNTY EYE CARE, LLC
Other - Org Name:DRS HARMON PETTY AND COLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:HARMON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-723-4752
Mailing Address - Street 1:488 W HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:IN
Mailing Address - Zip Code:47454-8807
Mailing Address - Country:US
Mailing Address - Phone:812-723-4752
Mailing Address - Fax:812-723-4753
Practice Address - Street 1:488 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454-8807
Practice Address - Country:US
Practice Address - Phone:812-723-4752
Practice Address - Fax:812-723-4753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001845A152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100194620BMedicaid
IN0324270001Medicare NSC
IN100194620BMedicaid