Provider Demographics
NPI:1740468743
Name:HOOSIER FAMILY EYECARE
Entity type:Organization
Organization Name:HOOSIER FAMILY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:K
Authorized Official - Last Name:DEWAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-876-6899
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:ELLETTSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47429-0278
Mailing Address - Country:US
Mailing Address - Phone:812-876-6899
Mailing Address - Fax:812-876-6809
Practice Address - Street 1:121 S 3RD ST
Practice Address - Street 2:
Practice Address - City:ELLETTSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47429-1507
Practice Address - Country:US
Practice Address - Phone:812-876-6899
Practice Address - Fax:812-876-6809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001552A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100152640AMedicaid
IN791580156OtherRAILROAD RETIREMENT
INT69239Medicare UPIN
IN0168180001Medicare NSC
IN435670Medicare PIN
INT69239Medicare UPIN
IN000000083800OtherANTHEM