Provider Demographics
NPI:1780606251
Name:LIVENGOOD, JAMES J (OD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:LIVENGOOD
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1400 N RITTER AVE
Mailing Address - Street 2:SUITE 281
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-3052
Mailing Address - Country:US
Mailing Address - Phone:317-357-8663
Mailing Address - Fax:317-357-5383
Practice Address - Street 1:1400 N RITTER AVE
Practice Address - Street 2:281
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3052
Practice Address - Country:US
Practice Address - Phone:317-357-8663
Practice Address - Fax:317-357-5383
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN18001715A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist