Healthcare Provider Details

I. General information

NPI: 1043291966
Provider Name (Legal Business Name): PROFESSIONAL EYE CARE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 08/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

553 E TOWN ST
COLUMBUS OH
43215-4856
US

IV. Provider business mailing address

553 E TOWN ST
COLUMBUS OH
43215-4856
US

V. Phone/Fax

Practice location:
  • Phone: 614-461-1885
  • Fax: 614-461-5730
Mailing address:
  • Phone: 614-461-1885
  • Fax: 614-461-5730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID P. DICKSON
Title or Position: PRESIDENT
Credential: O.D.
Phone: 614-461-1885