Hoosier Eye Doctor Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

18003199A Issued in IN

Legal business name

HOOSIER EYE DOCTOR INC

Practice address

4719 W State Road 46
Bloomington, IN 47404-9518

Phone

(812) 876-2020

Fax

(812) 935-2020

NPI assigned

Feb 27, 2013

Last updated

Apr 12, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jan Dittman

Title

Co-Manager

Phone

(812) 876-2020

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1361923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365724800000",
    "number": "1740520790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4719 W STATE ROAD 46",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474049518",
            "telephone_number": "812-876-2020",
            "fax_number": "812-935-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4719 W STATE ROAD 46",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474049518",
            "telephone_number": "812-876-2020",
            "fax_number": "812-935-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOOSIER EYE DOCTOR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-27",
        "last_updated": "2013-04-12",
        "status": "A",
        "authorized_official_last_name": "DITTMAN",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "CO-MANAGER",
        "authorized_official_telephone_number": "812-876-2020"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003199A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2013; 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.