Healthcare Provider Details

I. General information

NPI: 1194802694
Provider Name (Legal Business Name): DAN WENDORFF OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8603 S EMERSON AVE STE 105
INDIANAPOLIS IN
46237-9851
US

IV. Provider business mailing address

8603 S EMERSON AVE STE 105
INDIANAPOLIS IN
46237-9851
US

V. Phone/Fax

Practice location:
  • Phone: 317-887-2732
  • Fax: 317-887-1553
Mailing address:
  • Phone: 317-887-2732
  • Fax: 317-887-1553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number18002327A
License Number StateIN

VIII. Authorized Official

Name: DR. DANIEL DONALD WENDORFF
Title or Position: OWNER/PRESIDENT
Credential: O.D.
Phone: 317-887-2732