Provider Demographics
NPI:1225199607
Name:KALLNER, AARON TODD (OD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:TODD
Last Name:KALLNER
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 1:2002 ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-3650
Mailing Address - Country:US
Mailing Address - Phone:740-353-5351
Mailing Address - Fax:740-353-8647
Practice Address - Street 1:2002 ROBINSON AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-3650
Practice Address - Country:US
Practice Address - Phone:740-353-5351
Practice Address - Fax:740-353-8647
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4988152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2613970Medicaid
OH2613970Medicaid
OHU79989Medicare UPIN