Healthcare Provider Details

I. General information

NPI: 1386484657
Provider Name (Legal Business Name): ALYSSA MARIE MADINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2024
Last Update Date: 05/25/2024
Certification Date: 05/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2687 N MEMORIAL DR
LANCASTER OH
43130-1670
US

IV. Provider business mailing address

6581 HARSHMAN CT
REYNOLDSBURG OH
43068-5019
US

V. Phone/Fax

Practice location:
  • Phone: 740-687-0530
  • Fax: 740-687-0588
Mailing address:
  • Phone: 520-273-3611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberOP.017751-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: