Provider Demographics
NPI:1114926334
Name:GEORGE, DAVID H (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:GEORGE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 JEFFERSON ST
Mailing Address - Street 2:PORT CLINTON
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-1141
Mailing Address - Country:US
Mailing Address - Phone:419-734-2106
Mailing Address - Fax:419-734-3792
Practice Address - Street 1:222 JEFFERSON ST
Practice Address - Street 2:PORT CLINTON
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-1141
Practice Address - Country:US
Practice Address - Phone:419-734-2106
Practice Address - Fax:419-734-3792
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3027152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02487OtherPARAMOUNT HEALTHCARE
OH000000510602OtherANTHEM BCBS
OH0257181Medicaid
OHT78479Medicare UPIN
OH0257181Medicaid
0418730001Medicare NSC
0401354Medicare PIN