Provider Demographics
NPI:1598429029
Name:FUELLING, MEGAN BRIANNA (OD)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:BRIANNA
Last Name:FUELLING
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 1:1010 BOULDER RIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-0010
Mailing Address - Country:US
Mailing Address - Phone:260-493-1505
Mailing Address - Fax:
Practice Address - Street 1:1010 BOULDER RIDGE TRL
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-0010
Practice Address - Country:US
Practice Address - Phone:260-493-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-31
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004308A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300087508Medicaid