NPIMap

Organization Active NPI

Amedco Indiana LLC

Doing business as Wabash Valley Eye Center

  • Optometrist
  • Vincennes, IN
National Provider Identifier
1649265570
Registry record updated Oct 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
01028066A Issued in IN
Legal business name
AMEDCO INDIANA LLC
Doing business as
Wabash Valley Eye Center
Practice address
2020 Clearview Dr.
Vincennes, IN 47591
Phone
(812) 882-9600
Fax
(812) 882-2944
NPI assigned
Sep 16, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2013

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

Authorized official

Name
Erica Perreira
Title
Coo
Phone
(877) 881-0022

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 01028066A IN Primary

Addresses

Primary practice location

2020 Clearview Dr.
Vincennes, IN 47591

Mailing address

2020 S Clearview Dr
Vincennes, IN 47591-5576
Phone (812) 882-9600

Other identifiers 1

IdentifierTypeStateIssuer
200125980AMedicaidIN

Other names 1

  • Wabash Valley Eye Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Amedco Indiana LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

715 S 9th St
Petersburg, IN 47567
Phone (812) 354-9400

209 E Main St
Washington, IN 47501
Phone (812) 254-0990

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382486400000",
    "number": "1649265570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 S CLEARVIEW DR",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "475915576",
            "telephone_number": "812-882-9600",
            "fax_number": "812-882-2944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 CLEARVIEW DR.",
            "city": "VINCENNES",
            "state": "IN",
            "postal_code": "47591",
            "telephone_number": "812-882-9600",
            "fax_number": "812-882-2944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMEDCO INDIANA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-16",
        "last_updated": "2013-10-23",
        "status": "A",
        "authorized_official_last_name": "PERREIRA",
        "authorized_official_first_name": "ERICA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "877-881-0022"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "01028066A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200125980A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wabash Valley Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vincennes, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2013; 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.