Provider Demographics
NPI:1801617196
Name:AYAD, PAULINE (OD)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:AYAD
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 1:8239 HAMPTON CIR E
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-9348
Mailing Address - Country:US
Mailing Address - Phone:317-238-0071
Mailing Address - Fax:
Practice Address - Street 1:1921 E 53RD ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-3164
Practice Address - Country:US
Practice Address - Phone:765-649-2278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-21
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004543A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist