Provider Demographics
NPI:1588727101
Name:TILLMAN EYECARE PC
Entity type:Organization
Organization Name:TILLMAN EYECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:E
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-476-4936
Mailing Address - Street 1:1700 S GREEN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-5744
Mailing Address - Country:US
Mailing Address - Phone:812-476-4936
Mailing Address - Fax:812-962-4300
Practice Address - Street 1:1700 S GREEN RIVER RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-5744
Practice Address - Country:US
Practice Address - Phone:812-476-4936
Practice Address - Fax:812-962-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002713B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100241460AMedicaid
IN6410420001Medicare NSC
IN188200Medicare ID - Type Unspecified
IN100241460AMedicaid
IN250200Medicare PIN
INU52428Medicare UPIN