MEDICARE: RIVERSIDE EYE CENTER LLC

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	5788	OH

General Provider Information

NPI Number	:	1326530833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE EYE CENTER LLC

Provider Business Mailing Address
First Line	:	3434 RIVERSIDE DR
Second Line	:
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43221-1743
Country	:	US
Telephone Number	:	614-273-0393
Fax Number	:	614-273-0131

Provider Business Practice Location Address
First Line	:	3434 RIVERSIDE DR
Second Line	:
City	:	UPPER ARLINGTON
State	:	OH
Zip	:	43221-1743
Country	:	US
Telephone Number	:	614-273-0393
Fax Number	:	614-273-0131

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. DARRELL DYE
Credential	:	OD
Telephone Number	:	614-273-0393

Provider Enumeration Date	:	05/31/2018
Last Update Date	:	05/31/2018

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