Indiana University

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

INDIANA UNIVERSITY

Practice address

803 N Monroe St
Bloomington, IN 47404-3321

Phone

(812) 855-1671

Fax

(812) 855-5157

NPI assigned

Jun 14, 2006

Organization subpart

No

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

Authorized official

Name

Jennifer S Fisher

Title

Business MGR

Phone

(812) 856-3624

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Community Eye Care Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Indiana University

  • Optometrist
  • Bloomington, IN
  • NPI 1174566921

  O20040513001109

  Same enrollment
• Indiana University

  • Optometrist
  • Indianapolis, IN
  • NPI 1497799787

  O20040513001109

  Same enrollment

Locations

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1316476800000",
    "number": "1699718957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "803 N MONROE ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474043321",
            "telephone_number": "812-855-1671",
            "fax_number": "812-855-5157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 N MONROE ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474043321",
            "telephone_number": "812-855-1671",
            "fax_number": "812-855-5157"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-14",
        "last_updated": "2011-09-20",
        "status": "A",
        "authorized_official_last_name": "FISHER",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "BUSINESS MGR",
        "authorized_official_telephone_number": "812-856-3624"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000105528",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100184630 A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Eye Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Indiana Specialty Surgery Center, LLC
• Indiana Spine and Sports Inc.
• Indiana Telepsych NP, LLC
• Indiana University
• Indiana University
• Indiana University
• Indiana University Health Bloomington Inc
• Indiana University Health Bloomington Inc
• Indiana University Health Bloomington Inc
• Indiana University Health Bloomington Inc

• All providers in Bloomington, IN
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.