Provider Demographics
NPI:1063167302
Name:FAUDREE, ANITA L (OPTICIAN)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:L
Last Name:FAUDREE
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 W OREGON AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:OH
Mailing Address - Zip Code:44672-1135
Mailing Address - Country:US
Mailing Address - Phone:614-769-1530
Mailing Address - Fax:
Practice Address - Street 1:406 W OREGON AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:OH
Practice Address - Zip Code:44672-1135
Practice Address - Country:US
Practice Address - Phone:614-769-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician