Healthcare Provider Details

I. General information

NPI: 1225023047
Provider Name (Legal Business Name): AARON CHRISTOPHER MACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 TAYLOR STATION RD
COLUMBUS OH
43213-4400
US

IV. Provider business mailing address

245 TAYLOR STATION RD
COLUMBUS OH
43213-4400
US

V. Phone/Fax

Practice location:
  • Phone: 614-866-9134
  • Fax: 614-866-6964
Mailing address:
  • Phone: 614-866-9134
  • Fax: 614-866-6964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.081529
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: