NPIMap

Organization Active NPI

Eye Associates of Southern Indiana PC

  • Optometrist
  • Madison, IN
National Provider Identifier
1861566549
Registry record updated Oct 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18001637 Issued in IN
Legal business name
EYE ASSOCIATES OF SOUTHERN INDIANA PC
Practice address
441 Green Rd
Madison, IN 47250-2645
Phone
(812) 273-2020
Fax
(812) 273-4022
NPI assigned
Nov 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2015

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

Authorized official

Name
Ronda Boman
Title
Ins Supervisor
Phone
(812) 590-6157

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 18001637 IN Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 18001655 IN
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 18001510 IN

Addresses

Primary practice location

441 Green Rd
Madison, IN 47250-2645

Mailing address

441 Green Rd
Madison, IN 47250-2645
Phone (812) 273-2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160316001801 IN DME Supplier - Physician - Optometrist 4183688310 Practice locations: Madison, IN

Other NPIs with the same Medicare PAC ID 9

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Eye Associates of Southern Indiana441 Green Rd, Madison, IN 47250-2645(812) 273-2020 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses Accepts assignmentParticipating since Sep 19, 1996

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.

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445385600000",
    "number": "1861566549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "441 GREEN RD",
            "city": "MADISON",
            "state": "IN",
            "postal_code": "472502645",
            "telephone_number": "812-273-2020",
            "fax_number": "812-273-4022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "441 GREEN RD",
            "city": "MADISON",
            "state": "IN",
            "postal_code": "472502645",
            "telephone_number": "812-273-2020",
            "fax_number": "812-273-4022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE ASSOCIATES OF SOUTHERN INDIANA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2015-10-21",
        "status": "A",
        "authorized_official_last_name": "BOMAN",
        "authorized_official_first_name": "RONDA",
        "authorized_official_title_or_position": "INS SUPERVISOR",
        "authorized_official_telephone_number": "812-590-6157"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18001637",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18001655",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18001510",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.