MEDICARE: DAYTON OPTOMETRIC CENTER INC.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841460482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAYTON OPTOMETRIC CENTER INC.

Provider Business Mailing Address
First Line	:	40 SOUTHMOOR CIR NE
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45429-2450
Country	:	US
Telephone Number	:	937-293-8685
Fax Number	:	937-293-2337

Provider Business Practice Location Address
First Line	:	2440 WILMINGTON PIKE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-2459
Country	:	US
Telephone Number	:	937-293-8685
Fax Number	:	937-293-2337

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. HEATH BRADLEY GILBERT
Credential	:	O.D.
Telephone Number	:	937-293-8685

Provider Enumeration Date	:	03/11/2008
Last Update Date	:	05/02/2024

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