Healthcare Provider Details

I. General information

NPI: 1972683514
Provider Name (Legal Business Name): MARY W VANHOY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E COUNTY LINE RD SUITE
INDIANAPOLIS IN
46227-1004
US

IV. Provider business mailing address

624 E WALNUT ST APT 110
INDIANAPOLIS IN
46204-1639
US

V. Phone/Fax

Practice location:
  • Phone: 317-882-1527
  • Fax: 317-882-4092
Mailing address:
  • Phone: 317-687-9717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number18001568B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: