Provider Demographics
NPI:1639124761
Name:FAIMON, DONALD R (OD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:FAIMON
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 7062
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46207-7062
Mailing Address - Country:US
Mailing Address - Phone:812-855-8436
Mailing Address - Fax:812-855-1683
Practice Address - Street 1:744 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47405-3603
Practice Address - Country:US
Practice Address - Phone:812-855-8436
Practice Address - Fax:812-855-1683
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1239DT152W00000X
OH4279/T170152W00000X
IN18004065A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH77901999Medicaid
KY77540268Medicaid
OH77902757Medicaid
OH0849818Medicaid
OH77901981Medicaid
KY77540268Medicaid
KY410037135Medicare PIN
OH0699975Medicare PIN
OH410019585Medicare PIN
OH0849818Medicaid
OH0699971Medicare PIN
KY0388403Medicare PIN
OHU20622Medicare UPIN
OH410019759Medicare PIN