Provider Demographics
NPI:1700049533
Name:NEWBURGH EYE CARE, P.C.
Entity Type:Organization
Organization Name:NEWBURGH EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GILLES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-853-8191
Mailing Address - Street 1:8688 RUFFIAN LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-3411
Mailing Address - Country:US
Mailing Address - Phone:812-853-8191
Mailing Address - Fax:
Practice Address - Street 1:8688 RUFFIAN LN
Practice Address - Street 2:SUITE B
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-3411
Practice Address - Country:US
Practice Address - Phone:812-853-8191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002239261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000089373OtherANTHEM BCBS
INGI161240OtherCLARITY VISION
IN881070Medicare PIN
IN000000089373OtherANTHEM BCBS
IN0160680001Medicare NSC