Provider Demographics
NPI:1962533851
Name:EYE ASSOCIATES OF SOUTHERN INDIANA PC
Entity type:Organization
Organization Name:EYE ASSOCIATES OF SOUTHERN INDIANA PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER MD
Authorized Official - Prefix:
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-284-0660
Mailing Address - Street 1:302 W 14TH ST STE 100A
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3751
Mailing Address - Country:US
Mailing Address - Phone:812-280-2162
Mailing Address - Fax:812-284-3822
Practice Address - Street 1:643 COMANCHE TRAIL
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-1753
Practice Address - Country:US
Practice Address - Phone:502-227-4508
Practice Address - Fax:502-226-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1520DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00021169OtherRAILROAD MEDICARE
KY77000420Medicaid
KY000000280798OtherANTHEM
KY7589Medicare PIN
KYU86690Medicare UPIN
KY4900560001Medicare NSC