Provider Demographics
NPI:1457331795
Name:AUSTGEN, THERESA A (OD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:AUSTGEN
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 1:13845 SPRINGMILL RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7900
Mailing Address - Country:US
Mailing Address - Phone:317-571-9119
Mailing Address - Fax:
Practice Address - Street 1:1650 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1715
Practice Address - Country:US
Practice Address - Phone:317-924-6351
Practice Address - Fax:317-927-3098
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002098A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN190050Medicare ID - Type Unspecified
INE13628Medicare UPIN