Organization
NORTHSIDE EYECARE ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEFFREY D. IRVIN O.D. (OWNER)
(812) 401-7777
Entity
Organization
Contact information
Practice address
634 CROSS VALLEY CIR, EVANSVILLE, IN 47710-5238
(812) 401-7777
(812) 429-0392
Mailing address
634 CROSS VALLEY CIR, EVANSVILLE, IN 47710-5238
(812) 401-7777
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003164
IN
152W00000X
Optometrist
18003181
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200981140
—
IN
01
—
6503910001
DMERC
IN
01
—
DR3932
RAILROAD MEDICARE
IN
Enumeration date
07/31/2009
Last updated
01/21/2013
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