NPIMap

Organization Active NPI

Indiana Vision Development Center PC

  • Optometrist
  • Fort Wayne, IN
National Provider Identifier
1821059320
Registry record updated Oct 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18002177A Issued in IN
Legal business name
INDIANA VISION DEVELOPMENT CENTER PC
Practice address
10343 Dawsons Creek Blvd
Ste B BLDG 6
Fort Wayne, IN 46825-1906
Phone
(260) 497-7973
Fax
(260) 497-7986
NPI assigned
Apr 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2007

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

Authorized official

Name
Dr. Carl O Myers, OD
Title
President
Phone
(260) 497-7973

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X 18002177A IN Primary

Addresses

Primary practice location

10343 Dawsons Creek Blvd
Ste B BLDG 6
Fort Wayne, IN 46825-1906

Mailing address

10343 Dawsons Creek Blvd
Ste B BLDG 6
Fort Wayne, IN 46825-1906
Phone (260) 497-7973

Other identifiers 2

IdentifierTypeStateIssuer
200427750AMedicaidIN
5544260001OtherINDMEPOS

National Provider Directory

National Provider Directory

Locations

10343 Dawsons Creek Blvd
Fort Wayne, IN 46825
Phone (260) 497-7973

NPI Registry JSON

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

{
    "created_epoch": "1143849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192579200000",
    "number": "1821059320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10343 DAWSONS CREEK BLVD",
            "address_2": "STE B BLDG 6",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251906",
            "telephone_number": "260-497-7973",
            "fax_number": "260-497-7986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10343 DAWSONS CREEK BLVD",
            "address_2": "STE B BLDG 6",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468251906",
            "telephone_number": "260-497-7973",
            "fax_number": "260-497-7986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIANA VISION DEVELOPMENT CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-01",
        "last_updated": "2007-10-17",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-497-7973",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002177A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200427750A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMEPOS",
            "identifier": "5544260001",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 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.

Verify at the official NPI Registry.