Provider Demographics
NPI:1427358209
Name:JAMES D. FERGUSON OD PC
Entity type:Organization
Organization Name:JAMES D. FERGUSON OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-972-0904
Mailing Address - Street 1:8417 KENNEDY AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-1139
Mailing Address - Country:US
Mailing Address - Phone:219-838-2020
Mailing Address - Fax:219-838-0454
Practice Address - Street 1:8417 KENNEDY AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-1139
Practice Address - Country:US
Practice Address - Phone:219-838-2020
Practice Address - Fax:219-838-0454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002583A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200323790Medicaid
IN185608AMedicare PIN
IN200323790Medicaid