=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245286350
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OPHTHALMIC SURGEONS & CONSULTANTS OF OHIO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2006
-----------------------------------------------------
Last Update Date | 08/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 262 NEIL AVE SUITE 430
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43215-2362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-221-7464
-----------------------------------------------------
Fax | 614-884-0727
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 262 NEIL AVE SUITE 430
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43215-2362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-221-7464
-----------------------------------------------------
Fax | 614-884-0727
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | KENNETH V CAHILL
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 614-221-7464
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 35049318
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------