Healthcare Provider Details

I. General information

NPI: 1760898233
Provider Name (Legal Business Name): JOSEPH JOHN RAZZANO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2014
Last Update Date: 04/09/2020
Certification Date: 04/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 OLENTANGY RIVER RD
COLUMBUS OH
43212-1452
US

IV. Provider business mailing address

472 TIBET RD
COLUMBUS OH
43202-2232
US

V. Phone/Fax

Practice location:
  • Phone: 614-405-7899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number6312
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6312
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: