Healthcare Provider Details

I. General information

NPI: 1295650083
Provider Name (Legal Business Name): TAITUMN JOEY CLAIRE HARCOURT ABOC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 PROGRESS WAY
WILMINGTON OH
45177-7710
US

IV. Provider business mailing address

2825 PROGRESS WAY
WILMINGTON OH
45177-7710
US

V. Phone/Fax

Practice location:
  • Phone: 937-655-8137
  • Fax: 937-655-8188
Mailing address:
  • Phone: 937-655-8137
  • Fax: 937-655-8188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberOP.018027-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: