Revolutioneyes 2 LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

REVOLUTIONEYES 2 LLC

Practice address

11464 Lakeridge Dr
Fishers, IN 46037-7607

Phone

(317) 790-2015

Fax

(317) 708-7324

NPI assigned

Oct 20, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ashley Draheim

Title

Practice Manager

Phone

(317) 790-2015

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeremy Ciano, OD

  • Optometrist
  • Carmel, IN
  • NPI 1962526392
  NPD
• Kennedy Penny, OD

  • Optometrist
  • Carmel, IN
  • NPI 1023794195
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1697760000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697760000000",
    "number": "1104608348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11464 LAKERIDGE DR",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460377607",
            "telephone_number": "317-790-2015",
            "fax_number": "317-708-7324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11464 LAKERIDGE DR",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460377607",
            "telephone_number": "317-790-2015",
            "fax_number": "317-708-7324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTIONEYES 2 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-20",
        "last_updated": "2023-10-20",
        "certification_date": "2023-10-20",
        "status": "A",
        "authorized_official_last_name": "DRAHEIM",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "317-790-2015"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Susan Ann Rexing
• Brandon Reyes
• Racquel Kukita Reyes, MD
• Victoria Reyes
• Hannah Reyher

• Optometrist in Fishers, IN
• Providers in Fishers, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.