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General NPI Number Information
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NPI Number | 1992155204
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Entity Type | Organization
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Legal Business Name | KENNETH D BOLTZ OD LLC
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 5775 PERIMETER DR SUITE 160
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City | DUBLIN
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State | OH
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Zip | 43017-3238
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Country | US
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Telephone | 614-763-5775
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Fax | 614-675-3338
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Provider Business Mailing Address
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Address Line | 5775 PERIMETER DR SUITE 160
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City | DUBLIN
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State | OH
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Zip | 43017-3238
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Country | US
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Telephone | 614-763-5775
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Fax | 614-675-3338
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH D BOLTS
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Credential | OD
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Telephone | 614-284-0794
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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 | 3782
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License Number State | OH
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