MEDICARE: GERALD RICHARD PAGE OD

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	3367T586	OH

General Provider Information

NPI Number	:	1730207259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD RICHARD PAGE OD

Provider Business Mailing Address
First Line	:	1906 BETHEL ROAD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-1864
Country	:	US
Telephone Number	:	614-457-1159
Fax Number	:	614-457-2429

Provider Business Practice Location Address
First Line	:	1906 BETHEL ROAD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-1864
Country	:	US
Telephone Number	:	614-457-1159
Fax Number	:	614-457-2429

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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