Individual
ANGELA FAUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
70 E 68TH PL, MERRILLVILLE, IN 46410-3506
(219) 736-2020
Mailing address
70 E 68TH PL, MERRILLVILLE, IN 46410-3506
(219) 736-2020
(219) 769-3884
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18004146A
IN
152W00000X
Optometrist
18004146B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
IN
Enumeration date
02/20/2019
Last updated
02/20/2019
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