Healthcare Provider Details

I. General information

NPI: 1386331023
Provider Name (Legal Business Name): TINA OGDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50739 VALLEY PLAZA DR
SAINT CLAIRSVILLE OH
43950-1751
US

IV. Provider business mailing address

50739 VALLEY PLAZA DR
SAINT CLAIRSVILLE OH
43950-1751
US

V. Phone/Fax

Practice location:
  • Phone: 740-695-8418
  • Fax: 740-695-8424
Mailing address:
  • Phone: 740-695-8418
  • Fax: 740-695-8424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberSC4569
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: