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General NPI Number Information
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NPI Number | 1568736023
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Entity Type | Organization
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Legal Business Name | INDEPENDENT DOCTORS OF OPTOMETRY, LLC
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Dates
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Enumeration Date | 03/01/2012
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Last Update Date | 07/21/2020
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Provider Practice Location Address
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Address Line | 2687 N MEMORIAL DR
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City | LANCASTER
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State | OH
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Zip | 43130-1670
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Country | US
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Telephone | 740-687-0530
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Fax |
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Provider Business Mailing Address
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Address Line | 995 KENWOOD LN
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City | COLUMBUS
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State | OH
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Zip | 43220-4122
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Country | US
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Telephone | 614-893-1165
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DANIEL J. ROZZO
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Credential | O.D.
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Telephone | 614-893-1165
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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 | 3822
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License Number State | OH
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