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General NPI Number Information
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NPI Number | 1003002445
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Entity Type | Organization
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Legal Business Name | BETHEL VISION CENTER
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 05/16/2011
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Provider Practice Location Address
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Address Line | 1960 BETHEL RD SUITE 150
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City | COLUMBUS
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State | OH
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Zip | 43220
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Country | US
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Telephone | 614-459-4093
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Fax | 614-451-4051
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Provider Business Mailing Address
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Address Line | 1960 BETHEL RD SUITE 150
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City | COLUMBUS
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State | OH
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Zip | 43220
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Country | US
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Telephone | 614-459-4093
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Fax | 614-451-4051
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Authorized Official
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Title or Position | OWNER
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Name | DR. HOWARD D JORDAN
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Credential | O.D.
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Telephone | 614-459-4093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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