Provider Demographics
NPI:1386331023
Name:OGDEN, TINA
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:OGDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50739 VALLEY PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-1751
Mailing Address - Country:US
Mailing Address - Phone:740-695-8418
Mailing Address - Fax:740-695-8424
Practice Address - Street 1:50739 VALLEY PLAZA DR
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-1751
Practice Address - Country:US
Practice Address - Phone:740-695-8418
Practice Address - Fax:740-695-8424
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSC4569156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician