Provider Demographics
NPI:1417006354
Name:JOYNER, PAUL J (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:JOYNER
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 1:878 WOODRUFF PL E DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-1924
Mailing Address - Country:US
Mailing Address - Phone:317-638-8849
Mailing Address - Fax:
Practice Address - Street 1:1250 N STATE ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1055
Practice Address - Country:US
Practice Address - Phone:317-462-5949
Practice Address - Fax:317-462-6342
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001846152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100119960Medicaid
U37139Medicare UPIN
IN100119960Medicaid