MEDICARE: RONALD FARY PC

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	18002261A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000306292	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1629408711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RONALD FARY PC

Provider Business Mailing Address
First Line	:	6608 KANSAS AVE
Second Line	:
City	:	HAMMOND
State	:	IN
Zip	:	46323-1747
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6608 KANSAS AVE
Second Line	:
City	:	HAMMOND
State	:	IN
Zip	:	46323-1747
Country	:	US
Telephone Number	:	219-743-3309
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RONALD FARY
Credential	:	O.D.
Telephone Number	:	219-743-3309

Provider Enumeration Date	:	11/26/2013
Last Update Date	:	11/26/2013

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