Provider Demographics
NPI:1104172071
Name:POWERS, ELIZABETH LAUTH (OD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LAUTH
Last Name:POWERS
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 1:6920 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1038
Mailing Address - Country:US
Mailing Address - Phone:317-979-4889
Mailing Address - Fax:
Practice Address - Street 1:10610 N PENNSYLVANIA ST
Practice Address - Street 2:SUITE B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46280-2004
Practice Address - Country:US
Practice Address - Phone:317-844-6269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-30
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003746A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist