Provider Demographics
NPI:1790886547
Name:THE EYE GROUP OF SOUTHERN INDIANA, LLC
Entity Type:Organization
Organization Name:THE EYE GROUP OF SOUTHERN INDIANA, LLC
Other - Org Name:ENVISION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:PENLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-422-6977
Mailing Address - Street 1:1020 W BUENA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-5150
Mailing Address - Country:US
Mailing Address - Phone:812-422-6977
Mailing Address - Fax:812-426-7026
Practice Address - Street 1:1020 W BUENA VISTA RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-5150
Practice Address - Country:US
Practice Address - Phone:812-422-6977
Practice Address - Fax:812-426-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0332340001OtherDMERC
IN534080Medicare PIN