Provider Demographics
NPI:1871645689
Name:OAKLAND CITY EYECARE, LLC
Entity Type:Organization
Organization Name:OAKLAND CITY EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:IRVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-749-3700
Mailing Address - Street 1:251 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47660-1329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:251 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OAKLAND CITY
Practice Address - State:IN
Practice Address - Zip Code:47660-1329
Practice Address - Country:US
Practice Address - Phone:812-749-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200981140Medicaid
IN235680Medicare PIN
IN235680Medicare ID - Type Unspecified
IN5841660001Medicare NSC