Healthcare Provider Details

I. General information

NPI: 1245412477
Provider Name (Legal Business Name): HAROLD L. PICKENS, O.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 N 4TH ST
MARTINS FERRY OH
43935-1648
US

IV. Provider business mailing address

90 N 4TH ST
MARTINS FERRY OH
43935-1648
US

V. Phone/Fax

Practice location:
  • Phone: 740-633-2456
  • Fax: 740-633-2334
Mailing address:
  • Phone: 740-633-2456
  • Fax: 740-633-2334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3689 T792
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number3689 T792
License Number StateOH

VIII. Authorized Official

Name: DR. HAROLD L PICKENS
Title or Position: OWNER
Credential: O.D.
Phone: 740-633-2456