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NPI Code Detail

MEDICARE: ANGELA ALFRED O.D.

MEDICARE: ANGELA ALFRED 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
1152W00000XOptometrist18002798IN

General Provider Information

NPI Number : 1609811215
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA ALFRED O.D.
Provider Business Mailing Address
First Line : 4123 S MICHIGAN ST
Second Line :
City : SOUTH BEND
State : IN
Zip : 46614-2545
Country : US
Telephone Number : 574-291-8900
Fax Number : 574-299-8503
Provider Business Practice Location Address
First Line : 12 PROFESSIONAL CT
Second Line :
City : LAFAYETTE
State : IN
Zip : 47905-5152
Country : US
Telephone Number : 765-447-5083
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2006
Last Update Date : 07/08/2007

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Directions to “ ANGELA ALFRED O.D.” Practice Location

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