| |
12464 Lancaster St, Millersport, OH 43046-9787 | |
(740) 467-2525 | |
(740) 467-3015 |
Full Name | |
---|---|
Type | Facility |
Speciality | Optometrist |
Location | 12464 Lancaster St, Millersport, Ohio |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1780806067 | NPI | - | NPPES |
0294346 | Medicaid | OH | |
2235414 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 5109 (Ohio) | Primary |
Mailing Address | Practice Location Address |
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12464 Lancaster St, Po Box 421, Millersport, OH 43046-9787 Ph: (740) 467-2525 | 12464 Lancaster St, Millersport, OH 43046-9787 Ph: (740) 467-2525 |