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General NPI Number Information
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NPI Number | 1710900683
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Entity Type | Organization
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Legal Business Name | OHIO STATE UNIVERSITY
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 1664 NEIL AVE
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City | COLUMBUS
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State | OH
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Zip | 43201-2333
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Country | US
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Telephone | 614-292-2020
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Fax | 614-247-4543
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Provider Business Mailing Address
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Address Line | 1664 NEIL AVE
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City | COLUMBUS
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State | OH
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Zip | 43201-2333
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Country | US
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Telephone | 614-292-2020
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Fax | 614-247-4543
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Authorized Official
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Title or Position | ASSOCIATE DEAN OF CLINIC SERVICES
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Name | DR. GREGORY J NIXON
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Credential | OD, FAAO
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Telephone | 614-292-5367
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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 |
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License Number State |
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