Provider Demographics
NPI:1982686150
Name:STEGEMILLER, ANNA CAROLINE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:CAROLINE
Last Name:STEGEMILLER
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 1:441 AMOS RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-2245
Mailing Address - Country:US
Mailing Address - Phone:317-398-0305
Mailing Address - Fax:317-398-3116
Practice Address - Street 1:441 AMOS RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-2245
Practice Address - Country:US
Practice Address - Phone:317-398-0305
Practice Address - Fax:317-398-3116
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003364B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN230560BMedicare ID - Type Unspecified
INV05985Medicare UPIN