Individual
DR. MICHAEL L. FAGIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2007 E GREYHOUND PASS STE 4, CARMEL, IN 46033-7753
(317) 815-8302
(317) 815-8305
Mailing address
13753 STONE DR, CARMEL, IN 46032-9412
(317) 574-9276
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
18002571A
IN
152WC0802X
Corneal and Contact Management Optometrist
Primary
18002571B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18002571
STATE LICENSE
IN
Enumeration date
10/12/2006
Last updated
12/26/2007
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