Individual provider Active NPI

James L. Daugherty, O.D.

  • Optometrist
  • Fishers, IN
National Provider Identifier
1477725752
Registry record updated Nov 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18001586AB Issued in IN
Practice address
11559 Cumberland Rd
#300
Fishers, IN 46037-9787
Phone
(317) 594-5000
Fax
(317) 594-5056
NPI assigned
Mar 27, 2008
Last updated
Nov 4, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18001586AB IN Primary

Addresses

Primary practice location

11559 Cumberland Rd
#300
Fishers, IN 46037-9787

Mailing address

11559 Cumberland Rd
#300
Fishers, IN 46037-9787
Phone (317) 594-5000

Other identifiers 1

IdentifierTypeStateIssuer
100426950MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18001586ABINMDOptometrist

Organizations & group practices 1

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": "1206576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604448000000",
    "number": "1477725752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11559 CUMBERLAND RD",
            "address_2": "#300",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460379787",
            "telephone_number": "317-594-5000",
            "fax_number": "317-594-5056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11559 CUMBERLAND RD",
            "address_2": "#300",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460379787",
            "telephone_number": "317-594-5000",
            "fax_number": "317-594-5056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAUGHERTY",
        "first_name": "JAMES",
        "middle_name": "L.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-27",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18001586AB",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100426950",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fishers, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2020; 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.