Provider Demographics
NPI:1306039268
Name:AAVANG, DEANNE ROSE (OD)
Entity Type:Individual
Prefix:MISS
First Name:DEANNE
Middle Name:ROSE
Last Name:AAVANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 SAGAMORE PKWY S
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5124
Mailing Address - Country:US
Mailing Address - Phone:765-448-1477
Mailing Address - Fax:
Practice Address - Street 1:2415 SAGAMORE PKWY S
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5124
Practice Address - Country:US
Practice Address - Phone:765-448-1477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003460A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist