Healthcare Provider Details

I. General information

NPI: 1083672851
Provider Name (Legal Business Name): HAROLD L PICKENS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 N 4TH ST SUITE 21
MARTINS FERRY OH
43935-1648
US

IV. Provider business mailing address

90 N 4TH ST SUITE 21
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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: