Provider Demographics
NPI:1528123155
Name:INDIANA EYE SPECIALISTS, LLC
Entity type:Organization
Organization Name:INDIANA EYE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:FARBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-299-2020
Mailing Address - Street 1:76 W SPRINGHILL DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-8767
Mailing Address - Country:US
Mailing Address - Phone:812-299-2020
Mailing Address - Fax:812-299-0519
Practice Address - Street 1:76 W SPRINGHILL DR
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-8767
Practice Address - Country:US
Practice Address - Phone:812-299-2020
Practice Address - Fax:812-299-0519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200498750AMedicaid
IN200498750AMedicaid
IN249480Medicare PIN
IN5957500001Medicare NSC