MEDICARE: DR. PAMELA J. LOCKE O.D.

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	4949/T1819	OH

General Provider Information

NPI Number	:	1093718330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA J. LOCKE O.D.

Provider Business Mailing Address
First Line	:	410 N HYATT ST
Second Line	:
City	:	TIPP CITY
State	:	OH
Zip	:	45371-1434
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 N HYATT ST
Second Line	:
City	:	TIPP CITY
State	:	OH
Zip	:	45371-1434
Country	:	US
Telephone Number	:	937-294-6435
Fax Number	:

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	07/27/2023

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