Healthcare Provider Details

I. General information

NPI: 1417153156
Provider Name (Legal Business Name): JOHN JOSEPH SCHRIMPF LICENSED OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 MIAMISBURG CENTERVILLE RD 103
DAYTON OH
45459-3859
US

IV. Provider business mailing address

1989 MIAMISBURG CENTERVILLE RD 103
DAYTON OH
45459-3859
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-6060
  • Fax: 937-435-6860
Mailing address:
  • Phone: 937-435-6060
  • Fax: 937-435-6860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number0221A-SC
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: