Individual provider Active NPI

Timothy H. McGillen, O.D.

  • Optometrist
  • Merrillville, IN
National Provider Identifier
1285769133
Registry record updated Sep 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18001839B Issued in IN
Practice address
279 W 80TH PL
Merrillville, IN 46410-5491
Phone
(219) 738-2180
Fax
(219) 738-2847
NPI assigned
Feb 22, 2007
Last updated
Sep 9, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18001839B IN Primary

Addresses

Primary practice location

279 W 80TH PL
Merrillville, IN 46410-5491

Mailing address

9795 Crosspoint Blvd
Ste 100
Indianapolis, IN 46256-3354
Phone (317) 254-6480

Other identifiers 1

IdentifierTypeStateIssuer
201037950AMedicaidIN

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
I20060106000813 IN Practitioner - Optometry 1254354053 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18001839BINMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Indiana, LLC Optometrist Current Accepting new patients
Myeyedr Optometry of Indiana, LLC Optometrist CurrentSince Dec 31, 2018 Accepting new patients
Myeyedr Optometry of Indiana, LLC Optometrist CurrentSince Dec 31, 2018 Accepting new patients

Locations

7840 E 96th St
Fishers, IN 46037
Phone (317) 595-9999

9760 Lantern Rd
Fishers, IN 46037
Phone (317) 577-9200

980 Averitt Rd
Greenwood, IN 46143
Phone (317) 881-4143

804 Broad Ripple Ave
Indianapolis, IN 46220
Phone (317) 257-5421

279 W 80th Pl
Merrillville, IN 46410
Phone (219) 738-2180

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 4

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": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410220800000",
    "number": "1285769133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9795 CROSSPOINT BLVD",
            "address_2": "STE 100",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462563354",
            "telephone_number": "317-254-6480",
            "fax_number": "317-259-8609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "279 W 80TH PL",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464105491",
            "telephone_number": "219-738-2180",
            "fax_number": "219-738-2847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCGILLEN",
        "first_name": "TIMOTHY",
        "middle_name": "H.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-22",
        "last_updated": "2014-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18001839B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201037950A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Merrillville, IN

Sources for this page

Verify at the official NPI Registry.