Provider Demographics
NPI:1396733390
Name:TALLEY CATARACT AND LASER INSTITUTE
Entity type:Organization
Organization Name:TALLEY CATARACT AND LASER INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-435-1600
Mailing Address - Street 1:220 E VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47711-5530
Mailing Address - Country:US
Mailing Address - Phone:812-435-1600
Mailing Address - Fax:812-435-1603
Practice Address - Street 1:201 W IOWA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1721
Practice Address - Country:US
Practice Address - Phone:812-424-2020
Practice Address - Fax:812-424-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000054357OtherANTHEM
IN292OtherBC/BS KENTUCKY
KY36000743Medicaid
IN000000054357OtherANTHEM
KY36000743Medicaid
IL=========001Medicaid
INZE0560Medicare ID - Type Unspecified