Active NPI
Phonevilay Saysana, O.D.
- Optometrist
- Indianapolis, IN
National Provider Identifier
1710097597
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 18002951
- Practice address
- 10617 E Washington St
Indianapolis, IN 46229-2611 - Phone
- (317) 895-0536
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | 18002951 | IN | Primary |
Addresses
Primary practice location
10617 E Washington St
Indianapolis, IN 46229-2611
Mailing address
5354 W 300 S
New Palestine, IN 46163-9712
Phone (317) 861-5103
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 192310 | Other | IN | MEDICARE PROVIDER # |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18002951 | IN | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710097597",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5354 W 300 S",
"city": "NEW PALESTINE",
"state": "IN",
"postal_code": "461639712",
"telephone_number": "317-861-5103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10617 E WASHINGTON ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462292611",
"telephone_number": "317-895-0536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SAYSANA",
"first_name": "PHONEVILAY",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IN",
"license": "18002951",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PROVIDER #",
"identifier": "192310",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.