Provider Demographics
NPI:1154946044
Name:OPTOMETRIC MANAGEMENT GROUP LLC
Entity type:Organization
Organization Name:OPTOMETRIC MANAGEMENT GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-296-1175
Mailing Address - Street 1:2727 MALLARDS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8617
Mailing Address - Country:US
Mailing Address - Phone:614-296-1175
Mailing Address - Fax:614-326-1832
Practice Address - Street 1:1049 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2609
Practice Address - Country:US
Practice Address - Phone:614-326-1830
Practice Address - Fax:614-326-1832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty