Healthcare Provider Details

I. General information

NPI: 1598917213
Provider Name (Legal Business Name): SERVILIA AUGUSTINA VOSS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2377 E MAIN ST STE 130 EYEGLASS WORLD
PLAINFIELD IN
46168-2717
US

IV. Provider business mailing address

2377 E MAIN ST STE 130 EYEGLASS WORLD
PLAINFIELD IN
46168-2717
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-5658
  • Fax:
Mailing address:
  • Phone: 317-839-5658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003527A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: