Healthcare Provider Details

I. General information

NPI: 1063467892
Provider Name (Legal Business Name): DWB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 GRANDVIEW AVE
COLUMBUS OH
43212-2853
US

IV. Provider business mailing address

1421 GRANDVIEW AVE
COLUMBUS OH
43212-2853
US

V. Phone/Fax

Practice location:
  • Phone: 614-488-2020
  • Fax: 614-488-0763
Mailing address:
  • Phone: 614-488-2020
  • Fax: 614-488-0763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KAREN RICCIO
Title or Position: VICE PRESIDENT
Credential: OD
Phone: 614-488-2020