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General NPI Number Information
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NPI Number | 1255258232
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Entity Type | Individual
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Provider Name | ALEXANDRIA ROSE FANNING OD
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Gender | Female
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Dates
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Enumeration Date | 07/01/2026
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Last Update Date | 07/01/2026
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Provider Practice Location Address
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Address Line | 1400 N BALDWIN AVE
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City | MARION
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State | IN
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Zip | 46952-1929
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Country | US
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Telephone | 765-664-6148
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Fax |
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Provider Business Mailing Address
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Address Line | 14750 SILT WAY APT 306
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City | NOBLESVILLE
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State | IN
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Zip | 46062-9464
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Country | US
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Telephone | 765-721-7536
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18004682A
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License Number State | IN
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