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General NPI Number Information
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NPI Number | 1154946044
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Entity Type | Organization
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Legal Business Name | OPTOMETRIC MANAGEMENT GROUP LLC
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Dates
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Enumeration Date | 06/16/2020
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 1049 BETHEL RD
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City | COLUMBUS
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State | OH
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Zip | 43220-2609
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Country | US
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Telephone | 614-326-1830
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Fax | 614-326-1832
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Provider Business Mailing Address
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Address Line | 2727 MALLARDS LANDING DR
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City | POWELL
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State | OH
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Zip | 43065-8617
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Country | US
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Telephone | 614-296-1175
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Fax | 614-326-1832
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Authorized Official
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Title or Position | OWNER
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Name | JASON R MILLER
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Credential | OD
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Telephone | 614-296-1175
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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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