Provider Demographics
NPI:1316372303
Name:TICHENOR, ANNA ABLAMOWICZ (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:ABLAMOWICZ
Last Name:TICHENOR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:ABLAMOWICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 7062
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46207-7062
Mailing Address - Country:US
Mailing Address - Phone:812-855-4147
Mailing Address - Fax:855-856-6116
Practice Address - Street 1:744 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47405-3603
Practice Address - Country:US
Practice Address - Phone:812-855-8436
Practice Address - Fax:812-855-1683
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8332152W00000X
ALT-216-TA-977152W00000X
IN18004195152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112409104Medicaid
TX1861493140OtherGROUP NPI
IN1174566921OtherGROUP NPI