1992784599 NPI number — EVANS EYE CARE INC

Table of content: (NPI 1992784599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992784599 NPI number — EVANS EYE CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVANS EYE CARE INC
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:
EVANS PIGGOTT & FINNEY EYE CARE
Provider Other Organization Name Type Code:
3
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:
1992784599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3829 UNION ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47905-4454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-447-4951
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3829 UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47905-4454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-447-4951
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YARIAN
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
765-447-4951

Provider Taxonomy Codes

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

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

  • Identifier: 000000215340 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000215342 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000215343 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200315830 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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