Provider Demographics
NPI:1710098389
Name:EYECARE SPECIALISTS
Entity Type:Organization
Organization Name:EYECARE SPECIALISTS
Other - Org Name:DARLA HECK SACOPULOS OD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:HECK SACOPULOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-443-0060
Mailing Address - Street 1:325 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-2542
Mailing Address - Country:US
Mailing Address - Phone:812-443-0060
Mailing Address - Fax:812-446-5061
Practice Address - Street 1:325 W NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2542
Practice Address - Country:US
Practice Address - Phone:812-443-0060
Practice Address - Fax:812-446-5061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002508A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5460840001OtherDMERC
IN=========OtherTAX ID NUMBER
IN5460840001OtherDMERC