Provider Demographics
NPI:1740318005
Name:FAUNCE, RANDALL A (OD)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:A
Last Name:FAUNCE
Suffix:
Gender:M
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:PO BOX 39208
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-0208
Mailing Address - Country:US
Mailing Address - Phone:317-861-0755
Mailing Address - Fax:
Practice Address - Street 1:6829 W ROCKWOOD LN
Practice Address - Street 2:
Practice Address - City:NEW PALESTINE
Practice Address - State:IN
Practice Address - Zip Code:46163-8908
Practice Address - Country:US
Practice Address - Phone:317-861-0755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2014-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002075A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201140740Medicaid
IN411610002Medicare PIN