Healthcare Provider Details

I. General information

NPI: 1871425801
Provider Name (Legal Business Name): EMMA JEAN PENNINGTON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1154 S RIPLEY ESTATES DR
VERSAILLES IN
47042-9410
US

IV. Provider business mailing address

1487 INDIAN WOODS TRL
GREENDALE IN
47025-8673
US

V. Phone/Fax

Practice location:
  • Phone: 812-689-4721
  • Fax:
Mailing address:
  • Phone: 105-133-7301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004651B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: