Healthcare Provider Details

I. General information

NPI: 1093718330
Provider Name (Legal Business Name): PAMELA J. LOCKE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N HYATT ST
TIPP CITY OH
45371-1434
US

IV. Provider business mailing address

410 N HYATT ST
TIPP CITY OH
45371-1434
US

V. Phone/Fax

Practice location:
  • Phone: 937-294-6435
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4949/T1819
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: