Healthcare Provider Details

I. General information

NPI: 1023093531
Provider Name (Legal Business Name): CLEAR IMAGE MRI/CT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4995 BRADENTON AVE SUITE 100
DUBLIN OH
43017-3543
US

IV. Provider business mailing address

4995 BRADENTON AVE SUITE 100
DUBLIN OH
43017-3543
US

V. Phone/Fax

Practice location:
  • Phone: 614-659-9800
  • Fax: 614-659-9700
Mailing address:
  • Phone: 614-659-9800
  • Fax: 614-659-9700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471M1202X
TaxonomyMagnetic Resonance Imaging Radiologic Technologist
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. CHARLES CLARK
Title or Position: OFFICE MANAGER
Credential:
Phone: 614-659-9800