Provider Demographics
NPI:1790799021
Name:BRINEGAR EYE CARE, LLC
Entity Type:Organization
Organization Name:BRINEGAR EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRINEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-339-7995
Mailing Address - Street 1:4001 E 3RD ST STE 8
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5508
Mailing Address - Country:US
Mailing Address - Phone:812-339-7995
Mailing Address - Fax:812-339-7841
Practice Address - Street 1:4001 E 3RD ST STE 8
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5508
Practice Address - Country:US
Practice Address - Phone:812-339-7995
Practice Address - Fax:812-339-7841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002852152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INN265233OtherHARMONY HEALTH PLAN
IN000000334253OtherANTHEM BCBS
IN014498OtherSIHO
IN100362860BMedicaid
IN0005501569OtherAETNA
INN265233OtherHARMONY HEALTH PLAN
IN000000334253OtherANTHEM BCBS
IN0005501569OtherAETNA
IN014498OtherSIHO