Provider Demographics
NPI:1972656536
Name:CANIDA, JON RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:RICHARD
Last Name:CANIDA
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:PO BOX 50594
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-0594
Mailing Address - Country:US
Mailing Address - Phone:317-842-8444
Mailing Address - Fax:317-842-8649
Practice Address - Street 1:6905 E 96TH ST STE 1100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-4449
Practice Address - Country:US
Practice Address - Phone:317-576-9809
Practice Address - Fax:317-585-9823
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001886A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU31355Medicare UPIN
IN086300Medicare ID - Type Unspecified