Healthcare Provider Details

I. General information

NPI: 1326530833
Provider Name (Legal Business Name): RIVERSIDE EYE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3434 RIVERSIDE DR
UPPER ARLINGTON OH
43221-1743
US

IV. Provider business mailing address

3434 RIVERSIDE DR
UPPER ARLINGTON OH
43221-1743
US

V. Phone/Fax

Practice location:
  • Phone: 614-273-0393
  • Fax: 614-273-0131
Mailing address:
  • Phone: 614-273-0393
  • Fax: 614-273-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5788
License Number StateOH

VIII. Authorized Official

Name: DR. DARRELL DYE
Title or Position: OPTOMETRIST/OWNER
Credential: OD
Phone: 614-273-0393