Provider Demographics
NPI:1710353412
Name:DANVILLE FAMILY EYE CARE LLC
Entity Type:Organization
Organization Name:DANVILLE FAMILY EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:KEELY
Authorized Official - Middle Name:DOREEN
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-249-0100
Mailing Address - Street 1:95 N TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1223
Mailing Address - Country:US
Mailing Address - Phone:317-699-2000
Mailing Address - Fax:
Practice Address - Street 1:95 N TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1223
Practice Address - Country:US
Practice Address - Phone:317-699-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003426A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000490514OtherANTHEM PIN
INP00371968OtherMEDICARE RAILROAD
IN200854310Medicaid
IN186660EMedicare PIN
INP00371968OtherMEDICARE RAILROAD