Provider Demographics
NPI:1801255526
Name:CLEAR IMAGE EYE CENTER LLC
Entity type:Organization
Organization Name:CLEAR IMAGE EYE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAY-KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-291-0507
Mailing Address - Street 1:1209 S STATE ROAD 57
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-4367
Mailing Address - Country:US
Mailing Address - Phone:812-254-0990
Mailing Address - Fax:812-254-7730
Practice Address - Street 1:1209 S STATE ROAD 57
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4367
Practice Address - Country:US
Practice Address - Phone:812-254-0990
Practice Address - Fax:812-254-7730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002772A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty