Provider Demographics
NPI:1265407969
Name:TILLMAN, KURT E (OD)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:E
Last Name:TILLMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S GREEN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-5744
Mailing Address - Country:US
Mailing Address - Phone:812-476-4936
Mailing Address - Fax:812-962-4300
Practice Address - Street 1:1700 S GREEN RIVER RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-5744
Practice Address - Country:US
Practice Address - Phone:812-423-1142
Practice Address - Fax:812-962-4300
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002713B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000501097OtherBCBS
IN100464900AMedicaid
IN250200CMedicare PIN
U52428Medicare UPIN
IN6410420001Medicare NSC
IN250200BMedicare PIN