Healthcare Provider Details

I. General information

NPI: 1194722603
Provider Name (Legal Business Name): DAYTON OPTOMETRIC CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

813 TROY ST.
DAYTON OH
45404-1852
US

IV. Provider business mailing address

813 TROY ST.
DAYTON OH
45404-1852
US

V. Phone/Fax

Practice location:
  • Phone: 937-228-2020
  • Fax: 937-228-8769
Mailing address:
  • Phone: 937-228-2020
  • Fax: 937-228-8769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. RONALD MYRON GILBERT
Title or Position: PRESIDENT, D.O.C. JNC
Credential: OD
Phone: 937-228-2020