Provider Demographics
NPI:1972745057
Name:EYE ASSOCIATES GROUP, LLC
Entity Type:Organization
Organization Name:EYE ASSOCIATES GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-348-2020
Mailing Address - Street 1:926 W WALNUT ST
Mailing Address - Street 2:P O BOX 99
Mailing Address - City:ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47320-1530
Mailing Address - Country:US
Mailing Address - Phone:765-789-4404
Mailing Address - Fax:765-789-4466
Practice Address - Street 1:926 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47320-1530
Practice Address - Country:US
Practice Address - Phone:765-789-4404
Practice Address - Fax:765-789-4466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200005400Medicaid
IN1046420006Medicare NSC
IN465660Medicare PIN