| NPI | 1366572950 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL L. FAGIN Optometrist 317-841-0712 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2020-08-22 |