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General NPI Number Information
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NPI Number | 1770627804
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Entity Type | Organization
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Legal Business Name | MIKHAIL PETROV,O.D.,INC.
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 05/07/2014
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Provider Practice Location Address
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Address Line | 440 POLARIS PKWY SUITE 325
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City | WESTERVILLE
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State | OH
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Zip | 43082-6999
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Country | US
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Telephone | 614-436-9600
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Fax | 614-259-6546
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Provider Business Mailing Address
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Address Line | 440 POLARIS PKWY SUITE 325
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City | WESTERVILLE
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State | OH
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Zip | 43082-6999
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Country | US
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Telephone | 614-436-9600
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Fax | 614-259-6546
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MIKHAIL PETROV
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Credential | O.D.
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Telephone | 614-436-9600
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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 | 4909
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License Number State | OH
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