1255562377 NPI number — EYE CENTER OF SOUTHWESTERN INDIANA, P.C.

Table of content: (NPI 1255562377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255562377 NPI number — EYE CENTER OF SOUTHWESTERN INDIANA, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYE CENTER OF SOUTHWESTERN INDIANA, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255562377
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2020 SHERMAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCETON
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47670-1045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-385-2225
Provider Business Mailing Address Fax Number:
812-385-2314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1213 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62439-2332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-943-5713
Provider Business Practice Location Address Fax Number:
812-385-2314
Provider Enumeration Date:
08/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SATAR
Authorized Official First Name:
WAGIH
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
812-385-2225

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  046.010205 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 046.009184 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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