Healthcare Provider Details

I. General information

NPI: 1548330160
Provider Name (Legal Business Name): COLUMBUS OPTICAL SERVICE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 COTTAGE AVENUE
COLUMBUS IN
47201
US

IV. Provider business mailing address

2475 COTTAGE AVENUE
COLUMBUS IN
47201
US

V. Phone/Fax

Practice location:
  • Phone: 812-372-4117
  • Fax: 812-378-0245
Mailing address:
  • Phone: 812-372-4117
  • Fax: 812-378-0245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number111899
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number111899
License Number StateKY

VIII. Authorized Official

Name: MR. JOHN W. OLIVER
Title or Position: PRESIDENT/CEO
Credential: ABOC,NFOA, OAAR
Phone: 812-372-4117