Healthcare Provider Details

I. General information

NPI: 1871758292
Provider Name (Legal Business Name): JANNA L. VARGO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W BROAD ST 2ND FLOOR WESTSIDE HEALTH CENTER VISION
COLUMBUS OH
43204-3783
US

IV. Provider business mailing address

3433 AGLER ROAD SUITE 2300 - BILLING DEPT.
COLUMBUS OH
43219-3389
US

V. Phone/Fax

Practice location:
  • Phone: 614-859-1820
  • Fax: 614-458-1192
Mailing address:
  • Phone: 614-859-1939
  • Fax: 614-458-1849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.5825-THER
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: