Organization
TILLMAN EYECARE EAST P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL D VANDIVER (OFFICE MANAGER)
(812) 476-4936
Entity
Organization
Contact information
Practice address
1700 S GREEN RIVER RD, EVANSVILLE, IN 47715-5744
(812) 476-4936
(812) 962-4300
Mailing address
1700 S GREEN RIVER RD, EVANSVILLE, IN 47715-5744
(812) 476-4936
(812) 962-4300
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002713B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000356037
ANTHEM
IN
Enumeration date
07/08/2006
Last updated
03/17/2008
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