Provider Demographics
NPI:1871682013
Name:DOYLE, JACKIE L (OD)
Entity type:Individual
Prefix:DR
First Name:JACKIE
Middle Name:L
Last Name:DOYLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9400 FALL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4706
Mailing Address - Country:US
Mailing Address - Phone:317-845-0065
Mailing Address - Fax:
Practice Address - Street 1:DR. ERIC LEHR AND ASSOCIATES, P.C.
Practice Address - Street 2:6020 E. 82ND ST.
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250
Practice Address - Country:US
Practice Address - Phone:317-841-0712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002157A152W00000X
IN18002157B152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN18002157AOtherSTATE LICENSE
T91095Medicare UPIN