Provider Demographics
NPI:1861483612
Name:EYE CENTER GROUP, LLC
Entity Type:Organization
Organization Name:EYE CENTER GROUP, LLC
Other - Org Name:PORTLAND EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAPKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-286-8888
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47375-0457
Mailing Address - Country:US
Mailing Address - Phone:765-966-1945
Mailing Address - Fax:765-966-2975
Practice Address - Street 1:1111 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-1024
Practice Address - Country:US
Practice Address - Phone:260-726-4210
Practice Address - Fax:260-726-9347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2085863Medicaid
OH2085863Medicaid
INCA9626Medicare PIN
IN402810Medicare PIN