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General NPI Number Information
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NPI Number | 1114101912
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Entity Type | Organization
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Legal Business Name | JAMES D. FERGUSON OD PC
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 1820 E COLUMBUS DR
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City | EAST CHICAGO
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State | IN
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Zip | 46312-2826
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Country | US
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Telephone | 219-398-2020
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Fax | 291-398-9808
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Provider Business Mailing Address
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Address Line | 8417 KENNEDY AVE
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City | HIGHLAND
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State | IN
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Zip | 46322-1139
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Country | US
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Telephone | 219-838-2020
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Fax | 219-838-0454
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. DEBRA SMITH
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Credential |
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Telephone | 219-972-0904
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 18002583A
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License Number State | IN
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