Provider Demographics
NPI:1972683514
Name:VANHOY, MARY W (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:W
Last Name:VANHOY
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 1:624 E WALNUT ST APT 110
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1639
Mailing Address - Country:US
Mailing Address - Phone:317-687-9717
Mailing Address - Fax:
Practice Address - Street 1:1250 E COUNTY LINE RD
Practice Address - Street 2:SUITE
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1004
Practice Address - Country:US
Practice Address - Phone:317-882-1527
Practice Address - Fax:317-882-4092
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001568B152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN351850049100OtherCARESOURCE
INI001713OtherCHAMPUS
IN000000208291OtherBCBS
INT69240Medicare UPIN
IN000000208291OtherBCBS
IN264310CMedicare ID - Type Unspecified