Provider Demographics
NPI:1003046871
Name:BUCK, ERIN MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MICHELLE
Last Name:BUCK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1701 LIBRARY BLVD
Mailing Address - Street 2:SUITE I
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1567
Mailing Address - Country:US
Mailing Address - Phone:317-300-1460
Mailing Address - Fax:317-300-1487
Practice Address - Street 1:1701 LIBRARY BLVD
Practice Address - Street 2:SUITE I
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1567
Practice Address - Country:US
Practice Address - Phone:317-300-1460
Practice Address - Fax:317-300-1487
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003615A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400033549Medicare PIN