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NPI Code Detail

MEDICARE: OPTOMETRIC MANAGEMENT GROUP

MEDICARE: OPTOMETRIC MANAGEMENT GROUP
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
1152W00000XOptometrist5472OH

General Provider Information

NPI Number : 1316386501
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPTOMETRIC MANAGEMENT GROUP
Provider Business Mailing Address
First Line : 3959 HOOVER RD
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-2839
Country : US
Telephone Number : 614-875-8373
Fax Number : 614-875-0974
Provider Business Practice Location Address
First Line : 3959 HOOVER RD
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-2839
Country : US
Telephone Number : 614-875-8373
Fax Number : 614-875-0974
Authorized Official
Title or Position : CEO
Name : TIMOTHY FRIES
Credential : OD
Telephone Number : 740-335-2020
Provider Enumeration Date : 06/20/2013
Last Update Date : 09/02/2025

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Directions to “OPTOMETRIC MANAGEMENT GROUP ” Practice Location

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