Provider Demographics
NPI:1992784599
Name:EVANS EYE CARE INC
Entity type:Organization
Organization Name:EVANS EYE CARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:L
Authorized Official - Last Name:YARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-447-4951
Mailing Address - Street 1:3829 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4454
Mailing Address - Country:US
Mailing Address - Phone:765-447-4951
Mailing Address - Fax:
Practice Address - Street 1:3829 UNION ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4454
Practice Address - Country:US
Practice Address - Phone:765-447-4951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000215340OtherANTHEM
IN000000215342OtherANTHEM
IN000000215343OtherANTHEM BLUE CROSS
IN200315830Medicaid
IN000000215342OtherANTHEM
IN200315830Medicaid