Provider Demographics
NPI:1538395413
Name:ANANIAS OPTOMETRY INC., P.C.
Entity type:Organization
Organization Name:ANANIAS OPTOMETRY INC., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:ANANIAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:317-331-3933
Mailing Address - Street 1:9393 WESTFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1346
Mailing Address - Country:US
Mailing Address - Phone:317-331-3933
Mailing Address - Fax:
Practice Address - Street 1:7235 E 96TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-3308
Practice Address - Country:US
Practice Address - Phone:317-585-9453
Practice Address - Fax:317-585-9886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002809 A, B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty