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NPI Code Detail

MEDICARE: OPTOMETRIC MANAGEMENT GROUP LLC

MEDICARE: OPTOMETRIC MANAGEMENT GROUP LLC
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
1152W00000XOptometrist3677/T528OH

General Provider Information

NPI Number : 1265534093
Entity Type Code : Organization
Provider Name (Legal Business Name) : OPTOMETRIC MANAGEMENT GROUP LLC
Provider Business Mailing Address
First Line : 265 N LIBERTY ST
Second Line :
City : POWELL
State : OH
Zip : 43065-8870
Country : US
Telephone Number : 614-793-0700
Fax Number : 614-793-0084
Provider Business Practice Location Address
First Line : 265 N LIBERTY ST
Second Line :
City : POWELL
State : OH
Zip : 43065-8870
Country : US
Telephone Number : 614-793-0700
Fax Number : 614-793-0084
Authorized Official
Title or Position : CEO
Name : DR. JASON M MILLER
Credential : O.D.
Telephone Number : 614-793-0700
Provider Enumeration Date : 09/02/2006
Last Update Date : 07/02/2024

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Directions to “OPTOMETRIC MANAGEMENT GROUP LLC ” Practice Location

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