Healthcare Provider Details

I. General information

NPI: 1427180348
Provider Name (Legal Business Name): ODYSSEY AUDIOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9011 N MERIDIAN ST 205
INDIANAPOLIS IN
46260-5378
US

IV. Provider business mailing address

9011 N MERIDIAN ST 205
INDIANAPOLIS IN
46260-5378
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-8127
  • Fax: 317-844-1168
Mailing address:
  • Phone: 317-844-8127
  • Fax: 317-844-1168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23001452A
License Number StateIN

VIII. Authorized Official

Name: DR. SUZANNE SAMPSON OCONNOR
Title or Position: PRESIDENT
Credential: AUD
Phone: 317-844-8127