NPIMap

Organization Active NPI

Professional Eyecare Management, LLC

  • Optometrist
  • Evansville, IN
National Provider Identifier
1124170964
Registry record updated Nov 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
PROFESSIONAL EYECARE MANAGEMENT, LLC
Practice address
634 Cross Valley Cir
Evansville, IN 47710-5238
Phone
(812) 426-2256
Fax
(812) 429-0392
NPI assigned
Jan 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jeffrey D. Irvin, O.D.
Title
Owner
Phone
(812) 426-2256

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X IN Primary

Addresses

Primary practice location

634 Cross Valley Cir
Evansville, IN 47710-5238

Mailing address

634 Cross Valley Cir
Evansville, IN 47710-5238
Phone (812) 426-2256

Other identifiers 1

IdentifierTypeStateIssuer
200385820MedicaidIN

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258934400000",
    "number": "1124170964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "634 CROSS VALLEY CIR",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477105238",
            "telephone_number": "812-426-2256",
            "fax_number": "812-429-0392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "634 CROSS VALLEY CIR",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477105238",
            "telephone_number": "812-426-2256",
            "fax_number": "812-429-0392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL EYECARE MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "last_updated": "2009-11-23",
        "status": "A",
        "authorized_official_last_name": "IRVIN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-426-2256",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200385820",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.