Provider Demographics
NPI:1942556881
Name:OLUND, CANDICE LYNN (OD)
Entity Type:Individual
Prefix:MRS
First Name:CANDICE
Middle Name:LYNN
Last Name:OLUND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:CANDICE
Other - Middle Name:OLUND
Other - Last Name:YUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5455 HARRISON PARK LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46216-2245
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:357 W MORGAN ST STE C
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IN
Practice Address - Zip Code:47460-1255
Practice Address - Country:US
Practice Address - Phone:812-829-1254
Practice Address - Fax:812-829-3639
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003755152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201081460Medicaid
IN201081460Medicaid