Provider Demographics
NPI:1780695171
Name:BLUFFTON FAMILY EYE CARE, LLC
Entity type:Organization
Organization Name:BLUFFTON FAMILY EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:VAN WINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:260-824-3424
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:105 HARVEST RD
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-0374
Mailing Address - Country:US
Mailing Address - Phone:260-824-3424
Mailing Address - Fax:260-824-9116
Practice Address - Street 1:105 W HARVEST RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-9007
Practice Address - Country:US
Practice Address - Phone:260-824-3424
Practice Address - Fax:260-824-9116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001464152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherTAX ID
IN4211170001Medicare NSC
IN182520Medicare PIN
IN=========OtherTAX ID