| Whitson Vision, Pc | |
|
1115 Ronald Reagan Pkwy, Suite 223, Avon, IN 46123-6910 | |
| (317) 217-3937 | |
| (317) 217-3950 |
| Full Name | Whitson Vision, Pc |
|---|---|
| Type | Facility |
| Speciality | Ophthalmology |
| Location | 1115 Ronald Reagan Pkwy, Avon, Indiana |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568493005 | NPI | - | NPPES |
| 100072590D | Medicaid | IN | |
| 000000102683 | Other | IN | BC/BS GROUP # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | 18002221A (Indiana) | Secondary |
| 207W00000X | Ophthalmology | 01036301A (Indiana) | Primary |
| Provider Name | Padma P Ponugoti |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1952419004 PECOS PAC ID: 1355305343 Enrollment ID: I20041118000916 |
| Provider Name | Diana L Fisher |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1295899128 PECOS PAC ID: 4284672874 Enrollment ID: I20050423000070 |
| Provider Name | Craig Lee Mcmanis |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1689651275 PECOS PAC ID: 7012952427 Enrollment ID: I20050627000548 |
| Provider Name | William E Whitson |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1912935313 PECOS PAC ID: 1456329556 Enrollment ID: I20060126000294 |
| Provider Name | Kevin L Waltz |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1568405561 PECOS PAC ID: 4880761089 Enrollment ID: I20080929000731 |
| Provider Name | Alicia R Grove |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1568507275 PECOS PAC ID: 8123180452 Enrollment ID: I20081222000201 |
| Provider Name | Luis E Colon |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1255391686 PECOS PAC ID: 8426098856 Enrollment ID: I20100714000902 |
| Provider Name | Eve Nicole Grelle |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1861841942 PECOS PAC ID: 3375821333 Enrollment ID: I20161025002955 |
| Provider Name | Alyssa Marie Kehoe |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1730743519 PECOS PAC ID: 1052649928 Enrollment ID: I20220720001470 |
| Provider Name | Matthew R Doore |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1780274613 PECOS PAC ID: 7214341163 Enrollment ID: I20230726000916 |
| Mailing Address | Practice Location Address |
|---|---|
| Whitson Vision, Pc 901 E 86th St, Indianapolis, IN 46240-1807 Ph: (317) 844-5500 | Whitson Vision, Pc 1115 Ronald Reagan Pkwy, Suite 223, Avon, IN 46123-6910 Ph: (317) 217-3937 |