MEDICARE: CHESTNUT HILL EYE CARE, 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
1	152W00000X	Optometrist	OH4823	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1164427225	OTHER	OH	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1376693085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHESTNUT HILL EYE CARE, LLC

Provider Business Mailing Address
First Line	:	5081 N HAMILTON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-8001
Country	:	US
Telephone Number	:	614-478-8534
Fax Number	:

Provider Business Practice Location Address
First Line	:	5081 N HAMILTON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-8001
Country	:	US
Telephone Number	:	614-478-8534
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LINDA DAWSON
Credential	:	O.D.
Telephone Number	:	614-478-8534

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	08/22/2020

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