Healthcare Provider Details

I. General information

NPI: 1689846214
Provider Name (Legal Business Name): DUBOIS OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 WALNUT ST
CINCINNATI OH
45202-2516
US

IV. Provider business mailing address

645 WALNUT STREET
CINCINNATI OH
45202
US

V. Phone/Fax

Practice location:
  • Phone: 513-421-2911
  • Fax:
Mailing address:
  • Phone: 513-421-2911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number4729SC
License Number StateOH

VIII. Authorized Official

Name: MR. ANTHONY BRYAN STONE
Title or Position: OWNER
Credential: D.O.
Phone: 513-421-2911