MEDICARE: DR. AUSTIN DAVID POTTER 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	152W00000X	Optometrist	18003358A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000502302	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1508870742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUSTIN DAVID POTTER O.D.

Provider Business Mailing Address
First Line	:	3632 S CEDAR CREEK LN
Second Line	:
City	:	NEW PALESTINE
State	:	IN
Zip	:	46163-8719
Country	:	US
Telephone Number	:	317-753-8852
Fax Number	:

Provider Business Practice Location Address
First Line	:	5953 W BROADWAY
Second Line	:
City	:	MC CORDSVILLE
State	:	IN
Zip	:	46055-9355
Country	:	US
Telephone Number	:	317-747-9263
Fax Number	:	317-747-9271

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	05/08/2026

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