Healthcare Provider Details

I. General information

NPI: 1033340468
Provider Name (Legal Business Name): SAN-SAN COOLEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2009
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 N LIBERTY ST
POWELL OH
43065-8870
US

IV. Provider business mailing address

265 N LIBERTY ST
POWELL OH
43065-8870
US

V. Phone/Fax

Practice location:
  • Phone: 614-793-0700
  • Fax:
Mailing address:
  • Phone: 614-793-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5854
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: