Healthcare Provider Details

I. General information

NPI: 1114055530
Provider Name (Legal Business Name): EYE CLINIC OF WEST JEFFERSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 W MAIN ST
WEST JEFFERSON OH
43162-1229
US

IV. Provider business mailing address

94 W MAIN ST
WEST JEFFERSON OH
43162-1229
US

V. Phone/Fax

Practice location:
  • Phone: 614-879-7239
  • Fax: 614-879-1001
Mailing address:
  • Phone: 614-879-7239
  • Fax: 614-879-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5388
License Number StateOH

VIII. Authorized Official

Name: DR. SCOTT A FURGERSON
Title or Position: OWNER
Credential: O.D.
Phone: 614-879-7239