MEDICARE: OLENTANGY EYE AND LASER ASSOCIATES, INC.

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	207W00000X	Ophthalmology Physician		OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568412955
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OLENTANGY EYE AND LASER ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	3794 OLENTANGY RIVER RD.
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3455
Country	:	US
Telephone Number	:	614-267-4122
Fax Number	:	614-267-4242

Provider Business Practice Location Address
First Line	:	3794 OLENTANGY RIVER RD.
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3455
Country	:	US
Telephone Number	:	614-267-4122
Fax Number	:	614-267-4242

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MS. DEBBIE RIEGEL
Credential	:
Telephone Number	:	614-267-4122

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	01/27/2016

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Directions to “OLENTANGY EYE AND LASER ASSOCIATES, INC. ” Practice Location

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