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NPI Code Detail

MEDICARE: DR. JACLYN SUZANNE BUEHNER O.D.

MEDICARE: DR. JACLYN SUZANNE BUEHNER 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
1152W00000XOptometrist5703OH

General Provider Information

NPI Number : 1740464734
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACLYN SUZANNE BUEHNER O.D.
Provider Business Mailing Address
First Line : 3959 HOOVER RD
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-2839
Country : US
Telephone Number : 614-875-8373
Fax Number : 614-875-0974
Provider Business Practice Location Address
First Line : 3959 HOOVER RD
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-2839
Country : US
Telephone Number : 614-875-8373
Fax Number : 614-875-0974
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/26/2007
Last Update Date : 12/26/2007

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