Provider Demographics
NPI:1811034259
Name:BROWNSBURG FAMILY EYECARE PC
Entity Type:Organization
Organization Name:BROWNSBURG FAMILY EYECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-852-4741
Mailing Address - Street 1:90 HORNADAY ROAD
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-0809
Mailing Address - Country:US
Mailing Address - Phone:317-852-4741
Mailing Address - Fax:317-858-2967
Practice Address - Street 1:90 HORNADAY ROAD
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-0809
Practice Address - Country:US
Practice Address - Phone:317-852-4741
Practice Address - Fax:317-858-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001609B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN344600Medicare PIN
INU60188Medicare UPIN
IN0207570001Medicare NSC
INT83380Medicare UPIN
INT83381Medicare UPIN