Individual provider Active NPI

Nicholas Glen Phebus, O.D.

  • Optometrist
  • Indianapolis, IN
National Provider Identifier
1205210358
Registry record updated Jul 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18003920A Issued in IN
Practice address
5406 W 38TH St
Indianapolis, IN 46254-2918
Phone
(317) 280-8324
NPI assigned
Jul 17, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18003920A IN Primary

Addresses

Primary practice location

5406 W 38TH St
Indianapolis, IN 46254-2918

Mailing address

6553 N State Road 39
Mulberry, IN 46058-9435
Phone (765) 413-8768

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
I20221203000133 IN Practitioner - Optometry 5496124026 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Evans Eye Care IncGroup PAC ID 9830169234, 33 clinicians

Practice addresses (Care Compare)

1221 S Creasy LN
Suite a
Lafayette, IN 47905-7430
Phone (765) 447-4951

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery19

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18003920AINMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Evans Eye Care Inc Optometrist CurrentSince Sep 9, 2024 Accepting new patients
Duane a Gillam Optometrist Past Accepting new patients

Locations

1212 E Main St
Ste A
Attica, IN 47918
Phone (765) 762-2652

1221 S Creasy Ln
Ste A
Lafayette, IN 47905
Phone (765) 447-4951

3526 Osborne Ln
Lafayette, IN 47909
Phone (765) 447-4951

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1437091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437091200000",
    "number": "1205210358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6553 N STATE ROAD 39",
            "city": "MULBERRY",
            "state": "IN",
            "postal_code": "460589435",
            "telephone_number": "765-413-8768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5406 W 38TH ST",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462542918",
            "telephone_number": "317-280-8324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHEBUS",
        "first_name": "NICHOLAS",
        "middle_name": "GLEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-17",
        "last_updated": "2015-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003920A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.