Provider Demographics
NPI:1972517290
Name:FISHERS EYE CARE, LLC
Entity type:Organization
Organization Name:FISHERS EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-594-5000
Mailing Address - Street 1:11559 CUMBERLAND RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9787
Mailing Address - Country:US
Mailing Address - Phone:317-594-5000
Mailing Address - Fax:317-594-5056
Practice Address - Street 1:11559 CUMBERLAND RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9787
Practice Address - Country:US
Practice Address - Phone:317-594-5000
Practice Address - Fax:317-594-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001586AB152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100426950Medicaid
IN100426950Medicaid
IN198980Medicare PIN
INU40646Medicare UPIN