Active NPI
Debra L McConnaha, O.D.
- Low Vision Rehabilitation Optometrist
- Greenwood, IN
National Provider Identifier
1629070925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Low Vision Rehabilitation Optometrist
- License
- 18002361B
- Practice address
- 1634 W Smith Valley Rd
Ste a
Greenwood, IN 46142-1550 - Phone
- (317) 883-2020
- Fax
- (317) 883-2509
- NPI assigned
- Jun 1, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Low Vision Rehabilitation Optometrist | 152WL0500X | 18002361B | IN | Primary |
Addresses
Primary practice location
1634 W Smith Valley Rd
Ste a
Greenwood, IN 46142-1550
Mailing address
1634 W Smith Valley Rd
Ste a
Greenwood, IN 46142-1550
Phone (317) 883-2020
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201434685 | Other | IN | SAGAMORE |
| 000000220970 | Other | IN | ANTHEM |
| 4588556 | Other | IN | AETNA |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 18002361B | IN | MD | Low Vision Rehabilitation Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indiana University | Low Vision Rehabilitation | Past | Accepting new patients |
| Center Grove Eye Care, P.C. | Low Vision Rehabilitation | Past | Accepting new patients |
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": "1117584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445385600000",
"number": "1629070925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1634 W SMITH VALLEY RD",
"address_2": "STE A",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461421550",
"telephone_number": "317-883-2020",
"fax_number": "317-883-2509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1634 W SMITH VALLEY RD",
"address_2": "STE A",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461421550",
"telephone_number": "317-883-2020",
"fax_number": "317-883-2509"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCONNAHA",
"first_name": "DEBRA",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-06-01",
"last_updated": "2015-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "152WL0500X",
"taxonomy_group": "",
"desc": "Optometrist, Low Vision Rehabilitation",
"state": "IN",
"license": "18002361B",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SAGAMORE",
"identifier": "201434685",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000220970",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4588556",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenwood, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.