Provider Demographics
NPI:1760441380
Name:PEDIATRIC OPHTHALMOLOGY
Entity type:Organization
Organization Name:PEDIATRIC OPHTHALMOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDGEWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:614-224-6222
Mailing Address - Street 1:555 S 18TH ST
Mailing Address - Street 2:4-C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2654
Mailing Address - Country:US
Mailing Address - Phone:614-224-6222
Mailing Address - Fax:614-241-5232
Practice Address - Street 1:555 S 18TH ST
Practice Address - Street 2:4-C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2654
Practice Address - Country:US
Practice Address - Phone:614-224-6222
Practice Address - Fax:614-241-5232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty