Provider Demographics
NPI:1801015458
Name:EVANSVILLE EYECARE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:EVANSVILLE EYECARE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYWOOD-PFENDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-424-4444
Mailing Address - Street 1:213 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47708-1445
Mailing Address - Country:US
Mailing Address - Phone:812-424-4444
Mailing Address - Fax:812-424-2200
Practice Address - Street 1:213 MAIN ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1445
Practice Address - Country:US
Practice Address - Phone:812-424-4444
Practice Address - Fax:812-424-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN0255060001Medicare ID - Type UnspecifiedLEGACY