Provider Demographics
NPI: | 1700117249 |
---|---|
Name: | OHIO VALLEY EYE INSTITUTE |
Entity Type: | Organization |
Organization Name: | OHIO VALLEY EYE INSTITUTE |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | DAVID |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MALITZ |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 812-421-2020 |
Mailing Address - Street 1: | 1001 WALNUT STREET |
Mailing Address - Street 2: | |
Mailing Address - City: | EVANSVILLE |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 47713-1963 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 812-421-2020 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6540 LOGAN DR STE 3 |
Practice Address - Street 2: | |
Practice Address - City: | EVANSVILLE |
Practice Address - State: | IN |
Practice Address - Zip Code: | 47715-8238 |
Practice Address - Country: | US |
Practice Address - Phone: | 812-402-9620 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-01-22 |
Last Update Date: | 2010-01-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty |