Healthcare Provider Details

I. General information

NPI: 1528123403
Provider Name (Legal Business Name): MICHELLE L. VENEZIANO, O.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3045 NOE BIXBY RD
COLUMBUS OH
43232-5851
US

IV. Provider business mailing address

3045 NOE BIXBY RD
COLUMBUS OH
43232-5851
US

V. Phone/Fax

Practice location:
  • Phone: 614-837-3797
  • Fax: 614-837-9494
Mailing address:
  • Phone: 614-837-3797
  • Fax: 614-837-9494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5344
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number25-299822
License Number StateOH

VIII. Authorized Official

Name: DR. MICHELLE L VENEZIANO
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 614-837-3797