Individual
DR. ANDREW F MANSUETO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
942 RICHARD RD, DYER, IN 46311-1936
(219) 864-1430
Mailing address
942 RICHARD RD, P.O. BOX 367, DYER, IN 46311-1936
(219) 864-1430
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002573
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100424350A
—
IN
01
—
35-1883918
VSP
IN
Enumeration date
01/19/2006
Last updated
03/14/2012
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