Healthcare Provider Details

I. General information

NPI: 1891139176
Provider Name (Legal Business Name): GERALD R. PAGE, O.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2013
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BETHEL RD
COLUMBUS OH
43220-1864
US

IV. Provider business mailing address

1906 BETHEL RD
COLUMBUS OH
43220-1864
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-1159
  • Fax: 614-457-2429
Mailing address:
  • Phone: 614-457-1159
  • Fax: 614-457-2429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number3367T586
License Number StateOH

VIII. Authorized Official

Name: DR. GERALD R PAGE
Title or Position: PRESIDENT/OPTOMETRIST
Credential: O.D.
Phone: 614-457-1159