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General NPI Number Information
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NPI Number | 1932388816
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Entity Type | Organization
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Legal Business Name | SWEET OBENAUF EYECARE
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 9760 LANTERN RD
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City | FISHERS
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State | IN
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Zip | 46037-9612
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Country | US
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Telephone | 317-577-9200
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Fax | 317-570-4434
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Provider Business Mailing Address
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Address Line | 9760 LANTERN RD
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City | FISHERS
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State | IN
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Zip | 46037-9612
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Country | US
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Telephone | 317-577-9200
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Fax | 317-570-4434
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LORI K OBENAUF
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Credential | O.D
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Telephone | 317-577-9200
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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 | 18002527
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18002369
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License Number State | IN
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