Provider Demographics
NPI:1013948041
Name:THE EYE GROUP OF SOUTHERN INDIANA LLC
Entity Type:Organization
Organization Name:THE EYE GROUP OF SOUTHERN INDIANA LLC
Other - Org Name:THE EYE GROUP LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-423-3131
Mailing Address - Street 1:1020 W BUENA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-5150
Mailing Address - Country:US
Mailing Address - Phone:812-423-3131
Mailing Address - Fax:812-426-7020
Practice Address - Street 1:1020 W BUENA VISTA RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-5150
Practice Address - Country:US
Practice Address - Phone:812-423-3131
Practice Address - Fax:812-426-7020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031457A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200216310AMedicaid
IN534080Medicare ID - Type UnspecifiedMEDICARE GROUP #