Provider Demographics
NPI:1548269202
Name:FERGUSON, JAMES DANIEL (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DANIEL
Last Name:FERGUSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2007-07-20
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
IN18002583A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000229339OtherBLUE CROSS/BLUE SHIELD
IN185680Medicare ID - Type Unspecified