Provider Demographics
NPI:1649324831
Name:EYE ASSOCIATES GROUP, LLC
Entity type:Organization
Organization Name:EYE ASSOCIATES GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:TEAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-348-2020
Mailing Address - Street 1:PO BOX 166
Mailing Address - Street 2:
Mailing Address - City:HARTFORD CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47348-0166
Mailing Address - Country:US
Mailing Address - Phone:765-348-2020
Mailing Address - Fax:765-348-2503
Practice Address - Street 1:315 HUGGINS DR
Practice Address - Street 2:
Practice Address - City:HARTFORD CITY
Practice Address - State:IN
Practice Address - Zip Code:47348-8999
Practice Address - Country:US
Practice Address - Phone:765-348-2020
Practice Address - Fax:765-348-2503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCA7728OtherRRMC
IN200005400Medicaid
IN1046420001Medicare NSC
IN070720Medicare ID - Type UnspecifiedHC MEDICARE ID