Provider Demographics
NPI:1093536930
Name:APPLE OF THINE EYE LLC
Entity type:Organization
Organization Name:APPLE OF THINE EYE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED COSMETOLGIST/ CPCS
Authorized Official - Prefix:
Authorized Official - First Name:TOMEKA
Authorized Official - Middle Name:LASHALL
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:CRANIAL PROSTHESIS S
Authorized Official - Phone:812-545-7994
Mailing Address - Street 1:6520 E 82ND ST # 219
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-3600
Mailing Address - Country:US
Mailing Address - Phone:812-545-7994
Mailing Address - Fax:
Practice Address - Street 1:6520 E 82ND ST # 219
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-3600
Practice Address - Country:US
Practice Address - Phone:812-545-7994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty