Healthcare Provider Details

I. General information

NPI: 1457466278
Provider Name (Legal Business Name): THE EYESITE OF DUBLIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6535 PERIMETER DR AVERY SQUARE PLAZA
DUBLIN OH
43016
US

IV. Provider business mailing address

6535 PERIMETER DR
DUBLIN OH
43016
US

V. Phone/Fax

Practice location:
  • Phone: 614-764-7483
  • Fax: 614-764-7485
Mailing address:
  • Phone: 614-764-7483
  • Fax: 614-764-7485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. AMY L HAVENS
Title or Position: PRESIDENT
Credential: OD
Phone: 614-764-7483