Healthcare Provider Details

I. General information

NPI: 1205907953
Provider Name (Legal Business Name): ACKERSON EYECARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 CEMETERY RD
HILLIARD OH
43026-1102
US

IV. Provider business mailing address

4555 CEMETERY RD
HILLIARD OH
43026-1102
US

V. Phone/Fax

Practice location:
  • Phone: 614-876-4044
  • Fax: 614-876-0255
Mailing address:
  • Phone: 614-876-4044
  • Fax: 614-876-0255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3586
License Number StateOH

VIII. Authorized Official

Name: DR. LAIRD D ACKERSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: O.D.
Phone: 614-876-4044