Provider Demographics
NPI:1992032205
Name:CLINES EYE CARE, LLC
Entity Type:Organization
Organization Name:CLINES EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CLINES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:219-531-1624
Mailing Address - Street 1:1657 STONEY CREEK CT
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-6143
Mailing Address - Country:US
Mailing Address - Phone:219-531-1624
Mailing Address - Fax:219-865-5093
Practice Address - Street 1:1555 US HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1317
Practice Address - Country:US
Practice Address - Phone:219-865-6140
Practice Address - Fax:219-865-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002436152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN408370Medicare PIN
IN151800Medicare PIN
INU55693Medicare UPIN