Provider Demographics
NPI:1962635052
Name:WHITEWATER EYE CENTERS LLC
Entity Type:Organization
Organization Name:WHITEWATER EYE CENTERS LLC
Other - Org Name:WHITEWATER EYE CENTER RICHMOND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PART OWNER/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SCRIPTURE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-962-2020
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47375-0399
Mailing Address - Country:US
Mailing Address - Phone:765-962-2020
Mailing Address - Fax:765-966-2975
Practice Address - Street 1:1900 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1213
Practice Address - Country:US
Practice Address - Phone:765-962-2020
Practice Address - Fax:765-966-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3020671Medicaid
IN200962480CMedicaid
OH3020671Medicaid
IN200962480CMedicaid