Individual
PHONEVILAY SAYSANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
10617 E WASHINGTON ST, INDIANAPOLIS, IN 46229-2611
(317) 895-0536
Mailing address
5354 W 300 S, NEW PALESTINE, IN 46163-9712
(317) 861-5103
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18002951
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
192310
MEDICARE PROVIDER #
IN
Enumeration date
08/30/2006
Last updated
07/08/2007
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