Organization
EYE ASSOCIATES GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHELLEY TEAGLE (ACCOUNTS MANAGER)
(765) 348-2020
Entity
Organization
Contact information
Practice address
6208 CONSTITUTION DR STE B, FORT WAYNE, IN 46804-1585
(260) 432-0575
(260) 432-0835
Mailing address
6208 CONSTITUTION DR STE B, FORT WAYNE, IN 46804-1585
(260) 432-0575
(260) 432-0835
Taxonomy
Speciality
Code
Description
License number
State
152WL0500X
Low Vision Rehabilitation Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200005400
—
IN
Enumeration date
04/03/2009
Last updated
04/03/2009
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