Provider Demographics
NPI:1790798916
Name:EYE ASSOCIATES OPTICAL
Entity Type:Organization
Organization Name:EYE ASSOCIATES OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-896-1717
Mailing Address - Street 1:1101 N JIM DAY RD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-7218
Mailing Address - Country:US
Mailing Address - Phone:812-896-1717
Mailing Address - Fax:812-896-1296
Practice Address - Street 1:1101 N JIM DAY RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-7218
Practice Address - Country:US
Practice Address - Phone:812-896-1717
Practice Address - Fax:812-896-1296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5573930001Medicare NSC