Healthcare Provider Details

I. General information

NPI: 1033771878
Provider Name (Legal Business Name): CHAD KILLEN O.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 NEIL AVE
COLUMBUS OH
43201-2333
US

IV. Provider business mailing address

1664 NEIL AVE
COLUMBUS OH
43201-2333
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-2020
  • Fax: 614-247-4543
Mailing address:
  • Phone: 614-292-2020
  • Fax: 614-247-4543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007355
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: