Healthcare Provider Details

I. General information

NPI: 1376600882
Provider Name (Legal Business Name): FALL CREEK VISIONARIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11848 OLIO RD STE 300
FISHERS IN
46037-9189
US

IV. Provider business mailing address

11848 OLIO RD STE 300
FISHERS IN
46037-9189
US

V. Phone/Fax

Practice location:
  • Phone: 317-570-8100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003321B
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number18003321B
License Number StateIN

VIII. Authorized Official

Name: DR. KEVIN D. SMITH
Title or Position: OWNER
Credential: O.D.
Phone: 317-501-7872