MEDICARE: POONAM JOSHI PANDA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program		OH
2	152W00000X	Optometrist	T5057	OH
3	152W00000X	Optometrist	T7057	OH

General Provider Information

NPI Number	:	1184374779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POONAM JOSHI PANDA

Provider Business Mailing Address
First Line	:	50 MCNAUGHTEN RD STE 200
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2129
Country	:	US
Telephone Number	:	614-863-3937
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 MCNAUGHTEN RD STE 200
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2129
Country	:	US
Telephone Number	:	614-863-3937
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2022
Last Update Date	:	05/27/2022

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Directions to “ POONAM JOSHI PANDA ” Practice Location

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