Provider Demographics
NPI:1457577389
Name:ERIC BURRIS & JOSEPH LECLERE ET AL BURRIS LECLERE LLC
Entity type:Organization
Organization Name:ERIC BURRIS & JOSEPH LECLERE ET AL BURRIS LECLERE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LABHART
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-547-3396
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-0457
Mailing Address - Country:US
Mailing Address - Phone:812-547-3396
Mailing Address - Fax:812-547-5272
Practice Address - Street 1:8570 HIGHWAY 37
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-1705
Practice Address - Country:US
Practice Address - Phone:812-547-3396
Practice Address - Fax:812-547-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002159B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200378960Medicaid
IN200378960Medicaid
IN177270Medicare PIN
IN1285910001Medicare NSC
INT34962Medicare UPIN