Provider Demographics
NPI:1871608273
Name:ANANIAS, JAMES W JR (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:ANANIAS
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:9393 WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1346
Mailing Address - Country:US
Mailing Address - Phone:317-331-3933
Mailing Address - Fax:
Practice Address - Street 1:7235 E 96TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-3308
Practice Address - Country:US
Practice Address - Phone:317-585-9453
Practice Address - Fax:317-585-9886
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002809 A, B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU68827Medicare UPIN
IN381930Medicare ID - Type Unspecified