Healthcare Provider Details

I. General information

NPI: 1649181561
Provider Name (Legal Business Name): LICKING MEMORIAL HEALTH PROFESSIONALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W MAIN ST STE 100
NEWARK OH
43055-3676
US

IV. Provider business mailing address

1717 W MAIN ST STE 100
NEWARK OH
43055-3676
US

V. Phone/Fax

Practice location:
  • Phone: 220-564-3950
  • Fax: 220-564-3951
Mailing address:
  • Phone: 220-564-3950
  • Fax: 220-564-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA L. WEBSTER
Title or Position: VP, FINANCIAL SERVICES
Credential:
Phone: 220-564-4518