Provider Demographics
NPI:1962699975
Name:DAVID M. OHLE, O.D. LLC
Entity type:Organization
Organization Name:DAVID M. OHLE, O.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:OHLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-565-9002
Mailing Address - Street 1:154 GRANBY PL W
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-6209
Mailing Address - Country:US
Mailing Address - Phone:614-565-9002
Mailing Address - Fax:
Practice Address - Street 1:635 PARK MEADOW RD STE 213
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2877
Practice Address - Country:US
Practice Address - Phone:146-565-9002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4959152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDE1423OtherRAILROAD MEDICARE
OH2590889Medicaid
OH2590889Medicaid