Provider Demographics
NPI:1144485749
Name:AVILA, MEAGAN HILLARD (OD)
Entity type:Individual
Prefix:DR
First Name:MEAGAN
Middle Name:HILLARD
Last Name:AVILA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MEAGAN
Other - Middle Name:
Other - Last Name:HILLARD
Other - Suffix:
Other - Last Name Type:Former Name
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:317-256-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:12513 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-9150
Practice Address - Country:US
Practice Address - Phone:317-575-1133
Practice Address - Fax:317-575-6315
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003534A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000610125OtherANTHEM
IN000000610125OtherANTHEM
ININ1943015Medicare PIN