MEDICARE: DR. EMILY HERENDEEN OD

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	4901005660	MI
2	152W00000X	Optometrist	OPT.007324	OH

General Provider Information

NPI Number	:	1760189476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY HERENDEEN OD

Provider Business Mailing Address
First Line	:	1595 GEORGESVILLE SQUARE DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-3689
Country	:	US
Telephone Number	:	614-385-0088
Fax Number	:	614-385-0088

Provider Business Practice Location Address
First Line	:	1595 GEORGESVILLE SQUARE DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-3689
Country	:	US
Telephone Number	:	614-385-0088
Fax Number	:	614-385-0088

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

Provider Enumeration Date	:	02/13/2023
Last Update Date	:	08/21/2024

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