Provider Demographics
NPI:1336451715
Name:STREICH, BYRON LUKE WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:BYRON LUKE
Middle Name:WILLIAM
Last Name:STREICH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9795 CROSSPOINT BLVD
Mailing Address - Street 2:STE 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 1:980 AVERITT RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9540
Practice Address - Country:US
Practice Address - Phone:317-881-4143
Practice Address - Fax:317-259-8609
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003666A152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000718650OtherANTHEM
INA09951OtherEYEMED
INA09951OtherEYEMED