Provider Demographics
NPI:1295357879
Name:FISHERS EYE CARE OPTOMETRY LLC
Entity Type:Organization
Organization Name:FISHERS EYE CARE OPTOMETRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JILLIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PALL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-594-5000
Mailing Address - Street 1:11559 CUMBERLAND RD STE 300
Mailing Address - Street 2:
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:
Practice Address - Street 1:11559 CUMBERLAND RD STE 300
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty