NPIMap

Organization Active NPI

Eye Associates of Southern Indiana PC

  • Ophthalmology Physician
  • Jeffersonville, IN
National Provider Identifier
1336219922
Registry record updated Apr 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
EYE ASSOCIATES OF SOUTHERN INDIANA PC
Practice address
302 W 14TH St
#100
Jeffersonville, IN 47130
Phone
(812) 284-0660
Fax
(812) 284-3822
NPI assigned
Nov 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2013

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

Authorized official

Name
Ms. Ronda L Boman
Title
Ins Supervisor
Phone
(812) 258-4510

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

302 W 14TH St
#100
Jeffersonville, IN 47130

Mailing address

302 W 14TH St
#100
Jeffersonville, IN 47130
Phone (812) 284-0660

Other identifiers 1

IdentifierTypeStateIssuer
200013830MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, KY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20041117000139 IN Part B Supplier - Clinic/Group Practice 4183688310 Receives reassigned benefits from 15 practitioners
Practice locations: Corydon, IN; Jeffersonville, IN; Madison, IN; New Albany, IN; Salem, IN; Scottsburg, IN
O20050303000481 KY Part B Supplier - Clinic/Group Practice 4183688310 Receives reassigned benefits from 17 practitioners
Practice locations: Brandenburg, KY; Frankfort, KY; Louisville, KY
O20050303000562 IN Part B Supplier - Clinic/Group Practice 4183688310 Receives reassigned benefits from 12 practitioners
Practice locations: North Vernon, IN; Vevay, IN; Tell City, IN; Scottsburg, IN; Salem, IN; Paoli, IN; New Salisbury, IN; New Albany, IN…

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Eye Associates of S in PC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

441 Green Rd
Madison, IN 47250
Phone (812) 273-2020

1919 State St
Ste 140
New Albany, IN 47150
Phone (812) 280-2162

1350 S Jackson St
Salem, IN 47167
Phone (812) 896-1717

3703 Taylorsville Rd
Ste 120
Louisville, KY 40220
Phone (502) 451-5437

327 N Main St
Ste 3
Owenton, KY 40359
Phone (502) 484-5208

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366934400000",
    "number": "1336219922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 W 14TH ST",
            "address_2": "#100",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "47130",
            "telephone_number": "812-284-0660",
            "fax_number": "812-284-3822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 W 14TH ST",
            "address_2": "#100",
            "city": "JEFFERSONVILLE",
            "state": "IN",
            "postal_code": "47130",
            "telephone_number": "812-284-0660",
            "fax_number": "812-284-3822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE ASSOCIATES OF SOUTHERN INDIANA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2013-04-26",
        "status": "A",
        "authorized_official_last_name": "BOMAN",
        "authorized_official_first_name": "RONDA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "INS SUPERVISOR",
        "authorized_official_telephone_number": "812-258-4510",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200013830",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jeffersonville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2013; 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.