Provider Demographics
NPI:1720176183
Name:EXPERT EYECARE P C
Entity Type:Organization
Organization Name:EXPERT EYECARE P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURNETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-346-2020
Mailing Address - Street 1:401 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-1003
Mailing Address - Country:US
Mailing Address - Phone:812-346-2020
Mailing Address - Fax:812-346-4636
Practice Address - Street 1:401 HENRY ST
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-1003
Practice Address - Country:US
Practice Address - Phone:812-346-2020
Practice Address - Fax:812-346-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000103279OtherANTHEM
IN0430000001Medicare NSC
IN000000103279OtherANTHEM