Provider Demographics
NPI:1275521551
Name:STOVALL, NANCY C (OD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:C
Last Name:STOVALL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:CAROL
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:340 DAVID LIND DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-3410
Mailing Address - Country:US
Mailing Address - Phone:317-782-3476
Mailing Address - Fax:
Practice Address - Street 1:8139 PENDLETON PIKE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-4014
Practice Address - Country:US
Practice Address - Phone:317-898-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002855152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U66057Medicare UPIN
IN197360RMedicare ID - Type Unspecified