MEDICARE: DR. STACY E HUFNAGEL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	18003415A	IN
2	152WL0500X	Low Vision Rehabilitation Optometrist	18003415A	IN
3	152WP0200X	Pediatric Optometrist	18003415A	IN
4	152WS0006X	Sports Vision Optometrist	18003415A	IN

General Provider Information

NPI Number	:	1427116839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY E HUFNAGEL O.D.

Provider Business Mailing Address
First Line	:	2839 LAFAYETTE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-2147
Country	:	US
Telephone Number	:	317-924-1300
Fax Number	:	317-924-3741

Provider Business Practice Location Address
First Line	:	2839 LAFAYETTE RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46222-2147
Country	:	US
Telephone Number	:	317-924-1300
Fax Number	:	317-924-3741

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	04/23/2010

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