NPIMap

Organization Active NPI

Jean Paul Etienne, OD, PC

  • Optometrist
  • Bloomington, IN
National Provider Identifier
1891086583
Registry record updated Apr 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18003348B Issued in IN
Legal business name
JEAN PAUL ETIENNE, OD, PC
Practice address
3024 E 3Rd St
Bloomington, IN 47401-5425
Phone
(812) 330-2900
NPI assigned
Apr 28, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2011

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

Authorized official

Name
Dr. Jean Paul Etienne, OD
Title
President
Phone
(812) 345-1850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 18003348B IN Primary

Addresses

Primary practice location

3024 E 3Rd St
Bloomington, IN 47401-5425

Mailing address

729 N Keystone CT
Bloomington, IN 47408-2800
Phone (812) 345-1850

National Provider Directory

National Provider Directory

Locations

3024 E 3rd St
Bloomington, IN 47401
Phone (812) 330-2900

2896 E 3rd St
Bloomington, IN 47401
Phone (812) 332-9014

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1303948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303948800000",
    "number": "1891086583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "729 N KEYSTONE CT",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474082800",
            "telephone_number": "812-345-1850",
            "fax_number": "866-670-7077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3024 E 3RD ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474015425",
            "telephone_number": "812-330-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEAN PAUL ETIENNE, OD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-28",
        "last_updated": "2011-04-28",
        "status": "A",
        "authorized_official_last_name": "ETIENNE",
        "authorized_official_first_name": "JEAN PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "812-345-1850",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003348B",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2011; 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.