Randall A. Faunce, O.D.
Individual provider Active NPI Optometrist · New Palestine, IN
NPI 1740318005 · NPPES record last updated Jan 25, 2014
Key facts
- NPI
- 1740318005
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 18002075A (IN)
- Practice address
- 6829 W Rockwood LN
New Palestine, IN 46163-8908 - Phone
- (317) 861-0755
- NPI assigned
- Mar 1, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Indiana University - School of Optometry, 1983
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Family First Vision Care Indiana LLC
Practice addresses (Care Compare)
4201 Coldwater Rd
Fort Wayne, IN 46805-1113
Phone (260) 483-9568
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130501000126 | IN | Practitioner - Optometry | 5395982847 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Douglas C Morrow OD PC | Optometrist | Current |
Accepting new patients |
| Family First Vision Care Indiana LLC | Optometrist | Current |
Accepting new patients |
| Eyecare Indiana II, P.C. | Optometrist | Past | Accepting new patients |
Locations
1212 N Main St
Auburn, IN 46706
Phone (260) 925-1916
4201 Coldwater Rd
Fort Wayne, IN 46805
Phone (260) 483-9568
4150 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 483-9568
6502 Grape Rd
Mishawaka, IN 46545
Phone (574) 277-7723
316 S Hamilton Rd
Gahanna, OH 43230
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 18002075A | IN | Yes |
Addresses
Primary practice location
6829 W Rockwood LN
New Palestine, IN 46163-8908
Mailing address
PO Box 39208
Indianapolis, IN 46239-0208
Phone (317) 861-0755
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201140740 | Medicaid | IN |
Other providers in New Palestine, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.