Kimberly D Forniss, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18003112 Issued in IN

Practice address

5525 Georgetown Rd
Suite J
Indianapolis, IN 46254-3724

Phone

(317) 297-1788

Fax

(317) 297-1790

NPI assigned

May 4, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Optometry

Education

Southern College of Optometry, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aeg Indiana Professional PCGroup PAC ID 2365826179, 30 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Aeg Indiana Professional PC

  • Optometrist
  • Warsaw, IN
  • NPI 1043944127
  Medicare reassignment Care Compare group NPD
• Dr Tabitha G Temple PC

  • Optometrist
  • Warsaw, IN
  • NPI 1851484125
  NPD (past)

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226361600000",
    "number": "1720036668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5525 GEORGETOWN RD",
            "address_2": "SUITE J",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462543724",
            "telephone_number": "317-297-1788",
            "fax_number": "317-297-1790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5525 GEORGETOWN RD",
            "address_2": "SUITE J",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462543724",
            "telephone_number": "317-297-1788",
            "fax_number": "317-297-1790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORNISS",
        "first_name": "KIMBERLY",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2008-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200512000",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan Forman, OT
• Patricia Ann Forman
• Nicole Leigh Fornalik, PA-C
• Shelby Forney, PNP
• Forniss Optometric PC
• Erick Forno, MD
• Ann M Fornuto, MSW
• Greta Forrer
• Kevin Patrick Forrest, D.C., LAC.
• Tanikia Forrest

• Optometrist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.