Provider Demographics
NPI:1326028796
Name:FENIMORE, CRAIG A (OD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:FENIMORE
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 1:1818 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-9316
Mailing Address - Country:US
Mailing Address - Phone:765-932-4800
Mailing Address - Fax:765-932-2619
Practice Address - Street 1:1818 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-9316
Practice Address - Country:US
Practice Address - Phone:765-932-4800
Practice Address - Fax:765-932-2619
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002225152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000087303OtherANTHEM BLUE CROSS
NC100224620AOtherOPTICARE MANAGED VISION
IN100224620AOtherMDWISE/HOOSIER ALLIANCE
IN000000087303OtherANTHEM BCBS
INT69269OtherDME MAC UPIN
IN351734899OtherVISION SERVICE PLAN
IN351734899OtherVISION CARE INCORPORATED
IN0138200001OtherDME MAC
IN100224620AMedicaid
IN000000103026OtherANTHEM BCBS
IN0138200001OtherDMERC REG B
IN0138200001OtherDME MAC JURISDICTION B
IN0138200001Medicare NSC
IN710740Medicare PIN
INT69269OtherDME MAC UPIN