Provider Demographics
NPI:1528400678
Name:NEAL, AUTUMN BROOKE (OD)
Entity Type:Individual
Prefix:DR
First Name:AUTUMN
Middle Name:BROOKE
Last Name:NEAL
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 1:4801 W CLARA LN
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5548
Mailing Address - Country:US
Mailing Address - Phone:765-284-8460
Mailing Address - Fax:
Practice Address - Street 1:4801 W CLARA LN
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5548
Practice Address - Country:US
Practice Address - Phone:765-284-8460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003806A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist