MEDICARE: PLAIN CITY EYECARE

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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1194558825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAIN CITY EYECARE

Provider Business Mailing Address
First Line	:	206 W MAIN ST
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-4122
Country	:	US
Telephone Number	:	614-873-1003
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 W MAIN ST
Second Line	:
City	:	PLAIN CITY
State	:	OH
Zip	:	43064-4122
Country	:	US
Telephone Number	:	614-873-1003
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH RAZZANO
Credential	:	OD
Telephone Number	:	614-873-1003

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	08/20/2024

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Directions to “PLAIN CITY EYECARE ” Practice Location

Language	Start Address	Practice Location

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