Provider Demographics
NPI:1316920499
Name:MACHA, RAJENDER (OD)
Entity type:Individual
Prefix:DR
First Name:RAJENDER
Middle Name:
Last Name:MACHA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 S SCATTERFIELD RD
Mailing Address - Street 2:STE. B
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46016-5754
Mailing Address - Country:US
Mailing Address - Phone:765-649-1200
Mailing Address - Fax:765-649-4040
Practice Address - Street 1:1537 S SCATTERFIELD RD
Practice Address - Street 2:STE. B
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46016-5766
Practice Address - Country:US
Practice Address - Phone:765-649-1200
Practice Address - Fax:765-649-4040
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002944A152WL0500X, 152WS0006X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200198230AMedicaid