Healthcare Provider Details

I. General information

NPI: 1144164187
Provider Name (Legal Business Name): JOHN GEORGE POPONAS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9202 N MERIDIAN ST
INDIANAPOLIS IN
46260-1800
US

IV. Provider business mailing address

9202 N MERIDIAN ST
INDIANAPOLIS IN
46260-1800
US

V. Phone/Fax

Practice location:
  • Phone: 317-841-2020
  • Fax:
Mailing address:
  • Phone: 317-841-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004652A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: