=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205957990
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELLE ELIZABETH VANGETS O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2007
-----------------------------------------------------
Last Update Date | 04/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8500 KEYSTONE XING STE 150
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46240-4370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-624-2020
-----------------------------------------------------
Fax | 317-975-3993
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2666 LAKE CROSSING DR
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46143-9340
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-519-8445
-----------------------------------------------------
Fax | 317-975-3993
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2309
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 18003191A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------