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General NPI Number Information
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NPI Number | 1558513317
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Entity Type | Organization
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Legal Business Name | DR DAVID A. NIEDERKOHR INC.
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Dates
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Enumeration Date | 10/10/2008
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 25 NORTHWOOD DR
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City | DELAWARE
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State | OH
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Zip | 43015-1501
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Country | US
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Telephone | 740-369-7701
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Fax |
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Provider Business Mailing Address
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Address Line | 10197 ABBOTTS WAY
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City | POWELL
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State | OH
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Zip | 43065-6652
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Country | US
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Telephone | 614-785-9858
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID A. NIEDERKOHR
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Credential | O.D.
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Telephone | 740-369-7701
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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 | 3260T1062
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License Number State | OH
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