MEDICARE: DR. ERIC DEAN OSTREM O.D., M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4578	OH

General Provider Information

NPI Number	:	1043245566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC DEAN OSTREM O.D., M.S.

Provider Business Mailing Address
First Line	:	3363 TREMONT RD
Second Line	:	SUITE 303
City	:	COLUMBUS
State	:	OH
Zip	:	43221-2110
Country	:	US
Telephone Number	:	614-459-7980
Fax Number	:

Provider Business Practice Location Address
First Line	:	3363 TREMONT RD
Second Line	:	SUITE 303
City	:	COLUMBUS
State	:	OH
Zip	:	43221-2110
Country	:	US
Telephone Number	:	614-459-7980
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/09/2007

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