Provider Demographics
NPI:1154920049
Name:JANI, VIBHUTI PRIAN
Entity type:Individual
Prefix:
First Name:VIBHUTI
Middle Name:PRIAN
Last Name:JANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 N US HIGHWAY 31 N STE D
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-2409
Mailing Address - Country:US
Mailing Address - Phone:317-859-0129
Mailing Address - Fax:
Practice Address - Street 1:745 N US HIGHWAY 31 N STE D
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-2409
Practice Address - Country:US
Practice Address - Phone:317-859-9397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004246A207W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology