Individual provider Active NPI

Katie Shulist Connolly, O.D.

  • Optometrist
  • Bloomington, IN
National Provider Identifier
1164837506
Registry record updated Jan 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18003844A Issued in IN
Practice address
744 E 3Rd St
Bloomington, IN 47405-3603
Phone
(812) 855-8436
NPI assigned
Jun 24, 2014
Last updated
Jan 12, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18003844A IN Primary

Addresses

Primary practice location

744 E 3Rd St
Bloomington, IN 47405-3603

Mailing address

744 E 3Rd St
Bloomington, IN 47405-3603
Phone (812) 855-8436

Other identifiers 1

IdentifierTypeStateIssuer
201240730MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Direct@IndianaUnivSchoolOfOptomBloomingtonIN.CompulinkDirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140819001014 IN Practitioner - Optometry 8921225780 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ferris State College - College of Optometry, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Indiana UniversityGroup PAC ID 6002806957, 64 clinicians

Practice addresses (Care Compare)

1160 W Michigan St
100 Indianapolis Eye Care Center
Indianapolis, IN 46202-5209
Phone (317) 278-1470

744 E 3Rd St
Bloomington, IN 47405-3603
Phone (812) 855-8436

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18003844AINMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Indiana University Optometrist Current Accepting new patients
Indiana University Optometrist CurrentSince Jul 1, 2014 Accepting new patients
Indiana University CurrentSince Jul 1, 2014 Accepting new patients

Locations

744 E 3rd St
Bloomington, IN 47405
Phone (812) 855-8436

800 E Atwater Ave
Bloomington, IN 47405
Phone (812) 855-4447

1160 W Michigan St
Ste 100
Indianapolis, IN 46202
Phone (317) 278-1470

Interoperability endpoints

  • Direct secure messaging: direct@indianaunivschoolofoptombloomingtonin.compulinkdirect.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1403568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768176000000",
    "number": "1164837506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 E 3RD ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474053603",
            "telephone_number": "812-855-8436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 E 3RD ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474053603",
            "telephone_number": "812-855-8436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "KATIE",
        "middle_name": "SHULIST",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-24",
        "last_updated": "2026-01-12",
        "certification_date": "2026-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003844A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201240730",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Direct@IndianaUnivSchoolOfOptomBloomingtonIN.CompulinkDirect.com",
            "affiliation": "N",
            "endpointDescription": "IUSO direct email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "text",
            "address_1": "744 E 3rd St",
            "city": "Bloomington",
            "state": "IN",
            "country_code": "US",
            "postal_code": "474053603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

Verify at the official NPI Registry.