Provider Demographics
NPI:1790122489
Name:HALLUM, LAUREN E (OD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:E
Last Name:HALLUM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:E
Other - Last Name:WALTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:9795 CROSSPOINT BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3354
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:24 N EARL AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2813
Practice Address - Country:US
Practice Address - Phone:765-447-0880
Practice Address - Fax:765-447-4789
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003783152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201164030Medicaid