Healthcare Provider Details

I. General information

NPI: 1831330976
Provider Name (Legal Business Name): NORTHWEST EYECARE PROFESSIONALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2009
Last Update Date: 01/17/2012
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 Number5291 T2200
License Number StateOH

VIII. Authorized Official

Name: DR. DOUGLAS JOSEPH BOSNER
Title or Position: SOLE MEMBER
Credential: OD
Phone: 614-486-5205