Provider Demographics
NPI:1003926320
Name:NORTH STAR VISION CENTER AT OLENTANGY, L.L.C.
Entity Type:Organization
Organization Name:NORTH STAR VISION CENTER AT OLENTANGY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:D
Authorized Official - Last Name:STROHL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-326-1830
Mailing Address - Street 1:4885 OLENTANGY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1926
Mailing Address - Country:US
Mailing Address - Phone:614-326-1830
Mailing Address - Fax:614-326-1832
Practice Address - Street 1:4885 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1926
Practice Address - Country:US
Practice Address - Phone:614-326-1830
Practice Address - Fax:614-326-1832
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH STAR VISION CENTER AT OLENTANGY, L.L.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-30
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2742152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30034889906OtherMEDICAL MUTUAL
OH=========Medicare UPIN
OH30034889906OtherMEDICAL MUTUAL