Healthcare Provider Details

I. General information

NPI: 1366637316
Provider Name (Legal Business Name): JOHN RICHARD DICKINSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 N HOWARD ST
SABINA OH
45169-1150
US

IV. Provider business mailing address

28 N HOWARD ST
SABINA OH
45169-1150
US

V. Phone/Fax

Practice location:
  • Phone: 937-584-2020
  • Fax: 937-584-2080
Mailing address:
  • Phone: 937-584-2020
  • Fax: 937-584-2080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN RICHARD DICKINSON
Title or Position: OPTOMETRIST
Credential: DO
Phone: 937-584-2020