Individual provider Active NPI

Alexander Lineback, OD

  • Optometrist
  • Carmel, IN
National Provider Identifier
1750782983
Registry record updated Sep 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18003866A Issued in IN
Practice address
12905 Union Springs Dr
Carmel, IN 46032-4447
Phone
(260) 494-9366
NPI assigned
Sep 8, 2014
Last updated
Sep 8, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18003866A IN Primary

Addresses

Primary practice location

12905 Union Springs Dr
Carmel, IN 46032-4447

Mailing address

12905 Union Springs Dr
Carmel, IN 46032-4447

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20140925001211 IN Practitioner - Optometry 8820218852 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Nova Southeastern Univ College of Dental Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Frey Vision Group of Indiana IncGroup PAC ID 3779868203, 9 clinicians

Practice addresses (Care Compare)

3409 N Anthony Blvd
Fort Wayne, IN 46805-2233
Phone (260) 484-2691

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18003866AINMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Frey Vision Group of Indiana Inc Optometrist CurrentSince Apr 14, 2019 Accepting new patients
Longe Enterprises Corp PastSince Apr 11, 2021 Accepting new patients

Locations

10202 Coldwater Rd
Ste B
Fort Wayne, IN 46825
Phone (260) 469-0552

3409 N Anthony Blvd
Fort Wayne, IN 46805
Phone (260) 484-0615

5711 Ymca Park Dr E
Fort Wayne, IN 46835
Phone (224) 999-3129

6206 Saint Joe Center Rd
Fort Wayne, IN 46835
Phone (260) 492-2020

6413 Lima Rd
Fort Wayne, IN 46818
Phone (260) 275-5082

6709 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 432-8409

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1410134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410134400000",
    "number": "1750782983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12905 UNION SPRINGS DR",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460324447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12905 UNION SPRINGS DR",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460324447",
            "telephone_number": "260-494-9366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LINEBACK",
        "first_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-08",
        "last_updated": "2014-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003866A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carmel, IN

Sources for this page

Verify at the official NPI Registry.