Provider Demographics
NPI:1720045446
Name:FARABAUGH, ANNETTE F (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:F
Last Name:FARABAUGH
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 1:152 SANDRO ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-6005
Mailing Address - Country:US
Mailing Address - Phone:724-357-8308
Mailing Address - Fax:724-357-8308
Practice Address - Street 1:2334 OAKLAND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3348
Practice Address - Country:US
Practice Address - Phone:724-349-6220
Practice Address - Fax:724-349-5683
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001045152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAFA696524Medicare ID - Type Unspecified