MEDICARE: MARYELLEN SWARTZ LUEBBERS 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	5561	OH

General Provider Information

NPI Number	:	1396799391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYELLEN SWARTZ LUEBBERS O.D.

Provider Business Mailing Address
First Line	:	1421 GRANDVIEW AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-2853
Country	:	US
Telephone Number	:	614-488-2020
Fax Number	:	614-488-0763

Provider Business Practice Location Address
First Line	:	1421 GRANDVIEW AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43212-2853
Country	:	US
Telephone Number	:	614-488-2020
Fax Number	:	614-488-0763

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	08/19/2014

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