Provider Demographics
NPI:1902018849
Name:BUSBY EYE CARE, LLC
Entity Type:Organization
Organization Name:BUSBY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:BUSBY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-896-5005
Mailing Address - Street 1:16409 SOUTHPARK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8470
Mailing Address - Country:US
Mailing Address - Phone:317-896-5005
Mailing Address - Fax:317-896-5335
Practice Address - Street 1:16409 SOUTHPARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8470
Practice Address - Country:US
Practice Address - Phone:317-896-5005
Practice Address - Fax:317-896-5335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ18002880152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000328118OtherANTHEM
IN000000328118OtherANTHEM
INDQ7060Medicare PIN
IN210020Medicare PIN