Healthcare Provider Details

I. General information

NPI: 1194421156
Provider Name (Legal Business Name): DIANA L FISHER OD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8702 KEYSTONE XING
INDIANAPOLIS IN
46240-7621
US

IV. Provider business mailing address

15196 LARCHWOOD DR
WESTFIELD IN
46074-7947
US

V. Phone/Fax

Practice location:
  • Phone: 317-345-9312
  • Fax:
Mailing address:
  • Phone: 317-207-2868
  • Fax: 317-669-2016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DIANA L FISHER
Title or Position: OWNER
Credential: OD
Phone: 317-844-5500