Provider Demographics
NPI:1043245566
Name:OSTREM, ERIC DEAN (OD, MS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DEAN
Last Name:OSTREM
Suffix:
Gender:M
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3363 TREMONT RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2110
Mailing Address - Country:US
Mailing Address - Phone:614-459-7980
Mailing Address - Fax:
Practice Address - Street 1:3363 TREMONT RD
Practice Address - Street 2:SUITE 303
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2110
Practice Address - Country:US
Practice Address - Phone:614-459-7980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4578152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU77671Medicare UPIN
OHOS0893303Medicare ID - Type UnspecifiedMEDICARE