Healthcare Provider Details

I. General information

NPI: 1659411932
Provider Name (Legal Business Name): PATRICK DOLLENMAYER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4775 KNIGHTSBRIDGE BLVD SUITE 102
COLUMBUS OH
43214-4313
US

IV. Provider business mailing address

4775 KNIGHTSBRIDGE BLVD SUITE 102
COLUMBUS OH
43214-4313
US

V. Phone/Fax

Practice location:
  • Phone: 614-459-0600
  • Fax: 614-459-8750
Mailing address:
  • Phone: 614-459-0600
  • Fax: 614-459-8750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4274 - T804
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4274-T804
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: