Basic Information
| Provider Information | |||||||||
| NPI: | 1457331795 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUSTGEN | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13845 SPRINGMILL RD | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460327900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175719119 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1650 N COLLEGE AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462021715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179246351 | ||||||||
| FaxNumber: | 3179273098 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 18002098A | IN | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.