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General NPI Number Information
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NPI Number | 1679763577
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Entity Type | Organization
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Legal Business Name | PICKERINGTON EYECARE
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Dates
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Enumeration Date | 07/26/2007
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 141 CLINT DRIVE
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City | PICKERINGTON
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State | OH
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Zip | 43147
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Country | US
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Telephone | 614-575-0111
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Fax | 614-577-9214
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Provider Business Mailing Address
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Address Line | 141 CLINT DRIVE
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City | PICKERINGTON
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State | OH
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Zip | 43147
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Country | US
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Telephone | 614-575-0111
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Fax | 614-577-9214
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN D TRACY
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Credential | OD
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Telephone | 614-575-0111
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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 | 4686
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License Number State | OH
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