Eye Associates Group, LLC

Primary specialty

Low Vision Rehabilitation OptometristTaxonomy code 152WL0500X

Legal business name

EYE ASSOCIATES GROUP, LLC

Practice address

6208 Constitution Dr Ste B
Fort Wayne, IN 46804-1585

Phone

(260) 432-0575

Fax

(260) 432-0835

NPI assigned

Apr 3, 2009

Last updated

Apr 3, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shelley Teagle

Title

Accounts Manager

Phone

(765) 348-2020

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Eye Associates Group, LLC

  dba Low Vision Centers of Indiana

  • Optometrist
  • Hartford City, IN
  • NPI 1649324831

  O20080509000057

  Same enrollment
• Eye Associates Group, LLC

  • Optometrist
  • Albany, IN
  • NPI 1972745057

  O20080509000057

  Same enrollment

Locations

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

{
    "created_epoch": "1238716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238716800000",
    "number": "1144462235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6208 CONSTITUTION DR STE B",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041585",
            "telephone_number": "260-432-0575",
            "fax_number": "260-432-0835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6208 CONSTITUTION DR STE B",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468041585",
            "telephone_number": "260-432-0575",
            "fax_number": "260-432-0835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE ASSOCIATES GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-03",
        "last_updated": "2009-04-03",
        "status": "A",
        "authorized_official_last_name": "TEAGLE",
        "authorized_official_first_name": "SHELLEY",
        "authorized_official_title_or_position": "ACCOUNTS MANAGER",
        "authorized_official_telephone_number": "765-348-2020"
    },
    "taxonomies": [
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200005400",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenny Sue Eversman, PTA
• Drake M Everson, DO
• Everyday Counseling & Services LLC
• Raven Ewing, RBT
• Extended Care Specialists, Inc
• Eye Center Group LLC (Fort Wayne Eye Center)
• Eyecare Express
• Eyecare Express
• Eyemart Express LLC
• Eyemart Express, LTD.

• Low Vision Rehabilitation Optometrist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Low Vision Rehabilitation Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.