Mackenzie May Gershom, OD | |
5965 E Broad St Ste 480, Columbus, OH 43213-1562 | |
(614) 751-4070 | |
Not Available |
Full Name | Mackenzie May Gershom |
---|---|
Gender | Female |
Speciality | Optometrist |
Location | 5965 E Broad St Ste 480, Columbus, Ohio |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1386382877 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | OPT.007062 (Ohio) | Primary |
Provider Name | Cei Physicians Psc, Llc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1942296298 PECOS PAC ID: 0749186427 Enrollment ID: O20031211001059 |
Mailing Address | Practice Location Address |
---|---|
Mackenzie May Gershom, OD 1299 Tansy Ct, Tallmadge, OH 44278-2678 Ph: (330) 786-7857 | Mackenzie May Gershom, OD 5965 E Broad St Ste 480, Columbus, OH 43213-1562 Ph: (614) 751-4070 |
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