Provider Demographics
NPI:1205091097
Name:EADIE, JAMES ARTHUR (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ARTHUR
Last Name:EADIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8679 CONNECTICUT ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6386
Mailing Address - Country:US
Mailing Address - Phone:219-769-9022
Mailing Address - Fax:219-769-1918
Practice Address - Street 1:8679 CONNECTICUT ST STE A
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6383
Practice Address - Country:US
Practice Address - Phone:219-769-9022
Practice Address - Fax:219-769-1918
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036139514207W00000X
IN01076250A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400269650OtherMEDICARE ILLINOIS
IN496710004OtherMEDICARE
ILF400269646OtherIL MEDICARE