Healthcare Provider Details

I. General information

NPI: 1366854051
Provider Name (Legal Business Name): LAURA ANNE CAVADINI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ANNE LOMBARDINI D.O.

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 08/06/2024
Certification Date: 05/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 E DAY RD STE 100
MISHAWAKA IN
46545
US

IV. Provider business mailing address

230 E DAY RD STE 100
MISHAWAKA IN
46545-3408
US

V. Phone/Fax

Practice location:
  • Phone: 574-271-3939
  • Fax: 574-271-3941
Mailing address:
  • Phone: 574-271-3939
  • Fax: 574-271-3941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number02005399A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: