Provider Demographics
NPI:1801261235
Name:WHITEWATER EYE CENTERS, LLC
Entity type:Organization
Organization Name:WHITEWATER EYE CENTERS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:SCRIPTURE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-962-2020
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47375-0399
Mailing Address - Country:US
Mailing Address - Phone:765-962-2020
Mailing Address - Fax:765-966-2975
Practice Address - Street 1:510 W VOTAW ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-1322
Practice Address - Country:US
Practice Address - Phone:866-788-0001
Practice Address - Fax:765-966-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty