Provider Demographics
NPI:1821170499
Name:EYE CARE SURGERY CENTER OF EVANSVILLE, LLC
Entity Type:Organization
Organization Name:EYE CARE SURGERY CENTER OF EVANSVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:IRWIN
Authorized Official - Last Name:MALITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-421-2020
Mailing Address - Street 1:6540 LOGAN DRIVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-8238
Mailing Address - Country:US
Mailing Address - Phone:812-402-9620
Mailing Address - Fax:812-402-9277
Practice Address - Street 1:6540 LOGAN DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-8238
Practice Address - Country:US
Practice Address - Phone:812-402-9620
Practice Address - Fax:812-402-9277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
IN08-004274-1261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM300027111OtherMEDICARE CMS PTAN
89592OtherAAAHC CERTIFICATION