Healthcare Provider Details

I. General information

NPI: 1073380671
Provider Name (Legal Business Name): GERALDINE OGUNTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BRITTON PKWY
DUBLIN OH
43016-1207
US

IV. Provider business mailing address

5900 BRITTON PKWY
DUBLIN OH
43016-1207
US

V. Phone/Fax

Practice location:
  • Phone: 614-717-9645
  • Fax: 614-717-9651
Mailing address:
  • Phone: 614-717-9645
  • Fax: 614-717-9651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberOP.017630-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: