Provider Demographics
NPI:1760404024
Name:PENNINGTON, JAMES H (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:PENNINGTON
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 1:12101 LIMA RD.
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-9563
Mailing Address - Country:US
Mailing Address - Phone:260-637-3166
Mailing Address - Fax:260-637-3536
Practice Address - Street 1:12101 LIMA RD.
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-9563
Practice Address - Country:US
Practice Address - Phone:260-637-3166
Practice Address - Fax:260-637-3536
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001491B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU02679Medicare UPIN
IN951940Medicare ID - Type Unspecified