Provider Demographics
NPI:1316970346
Name:SOUTHERN INDIANA EYE ASSOCIATES LLC
Entity type:Organization
Organization Name:SOUTHERN INDIANA EYE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ENGLERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-482-6424
Mailing Address - Street 1:200 SAINT CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-9053
Mailing Address - Country:US
Mailing Address - Phone:812-482-6424
Mailing Address - Fax:812-634-9701
Practice Address - Street 1:200 SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9053
Practice Address - Country:US
Practice Address - Phone:812-482-6424
Practice Address - Fax:812-634-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050488A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200479960AMedicaid
IN213760Medicare PIN
IN6355940001Medicare NSC