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General NPI Number Information
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NPI Number | 1376703850
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Entity Type | Organization
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Legal Business Name | JAMES L EDICK OD LLC
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Dates
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Enumeration Date | 06/10/2008
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 6116 BOARDWALK ST
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City | COLUMBUS
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State | OH
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Zip | 43229
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Country | US
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Telephone | 614-430-8964
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Fax | 614-430-8965
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Provider Business Mailing Address
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Address Line | 6116 BOARDWALK ST
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City | COLUMBUS
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State | OH
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Zip | 43229
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Country | US
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Telephone | 614-430-8964
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Fax | 614-430-8965
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JAMES LAURENCE EDICK
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Credential | OD
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Telephone | 614-430-8964
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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 | 3795
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License Number State | OH
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