Healthcare Provider Details

I. General information

NPI: 1346214848
Provider Name (Legal Business Name): DOUGLAS JOSEPH BOSNER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2098 TREMONT CTR
COLUMBUS OH
43221-3108
US

IV. Provider business mailing address

2098 TREMONT CTR
COLUMBUS OH
43221-3108
US

V. Phone/Fax

Practice location:
  • Phone: 614-486-5205
  • Fax: 614-486-0354
Mailing address:
  • Phone: 614-486-5205
  • Fax: 614-486-0354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberS291
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT2200
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: