Healthcare Provider Details

I. General information

NPI: 1003630385
Provider Name (Legal Business Name): DUBLIN JEROME EYECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 03/10/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11902 SYCAMORE TRACE
PLAIN CITY OH
43064
US

IV. Provider business mailing address

11902 SYCAMORE TRACE
PLAIN CITY OH
43064
US

V. Phone/Fax

Practice location:
  • Phone: 614-733-8522
  • Fax: 614-733-8544
Mailing address:
  • Phone: 614-733-8522
  • Fax: 614-733-8544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOSEPH RAZZANO
Title or Position: OWNER
Credential: OD
Phone: 614-873-1003