1245522275 NPI number — WHITEWATER EYE CENTERS, LLC

Table of content: (NPI 1245522275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245522275 NPI number — WHITEWATER EYE CENTERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHITEWATER EYE CENTERS, LLC
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:
6
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:
1245522275
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 399
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47375-0399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-962-2020
Provider Business Mailing Address Fax Number:
765-966-2975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
127 LYNN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45056-1548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-788-0001
Provider Business Practice Location Address Fax Number:
765-966-2975
Provider Enumeration Date:
05/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SCRIPTURE
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
765-962-2020

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200962480D , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3153920 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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