Provider Demographics
NPI:1720352024
Name:EYE ASSOCIATES OF SOUTHERN INDIANA P.C.
Entity Type:Organization
Organization Name:EYE ASSOCIATES OF SOUTHERN INDIANA P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-284-0660
Mailing Address - Street 1:302 W 14TH ST.
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130
Mailing Address - Country:US
Mailing Address - Phone:812-284-0660
Mailing Address - Fax:812-284-3822
Practice Address - Street 1:1102 LYNDON LN
Practice Address - Street 2:SUITE A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4318
Practice Address - Country:US
Practice Address - Phone:502-426-0307
Practice Address - Fax:812-284-3822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies