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General NPI Number Information
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NPI Number | 1861014383
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Entity Type | Organization
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Legal Business Name | POLARIS VEIN CENTER, LLC
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 121 W WILSON BRIDGE RD STE 310
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City | WORTHINGTON
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State | OH
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Zip | 43085-2702
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Country | US
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Telephone | 614-488-5090
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Fax | 614-845-5216
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Provider Business Mailing Address
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Address Line | 121 W WILSON BRIDGE RD STE 310
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City | WORTHINGTON
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State | OH
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Zip | 43085-2702
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Country | US
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Telephone | 614-488-5090
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Fax | 614-845-5216
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Authorized Official
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Title or Position | DOM
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Name | AMANDA SUZANNE COOPER
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Credential | MD
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Telephone | 614-264-8970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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