Healthcare Provider Details

I. General information

NPI: 1952715369
Provider Name (Legal Business Name): JEFFREY COLE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10566 LOVELAND MADEIRA RD
LOVELAND OH
45140-8962
US

IV. Provider business mailing address

5303 GLENWAY AVE
CINCINNATI OH
45238-3706
US

V. Phone/Fax

Practice location:
  • Phone: 513-683-3791
  • Fax: 513-683-0366
Mailing address:
  • Phone: 513-921-8040
  • Fax: 513-921-6483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6274
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: