Individual
ORLANDO AVENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
707 NORTH MICHIGAN STREET, SUITE 210, SOUTH BEND, IN 46601-1069
(574) 233-2114
(574) 288-8921
Mailing address
707 NORTH MICHIGAN STREET, SUITE 210, SOUTH BEND, IN 46601-1069
(574) 233-2114
(574) 288-8921
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18004002A
IN
152W00000X
Optometrist
4901005097
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300015571
—
IN
Enumeration date
10/25/2016
Last updated
02/01/2022
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