Provider Demographics
NPI:1043567332
Name:FANNIN, ADAM J (OD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:J
Last Name:FANNIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-344-5555
Mailing Address - Fax:859-344-5552
Practice Address - Street 1:374 NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-7038
Practice Address - Country:US
Practice Address - Phone:812-496-8782
Practice Address - Fax:812-539-1800
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6118152W00000X
KY2213DT152W00000X
IN18004500A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist