Provider Demographics
NPI:1235919234
Name:IMBODEN, CARI
Entity Type:Individual
Prefix:
First Name:CARI
Middle Name:
Last Name:IMBODEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 NYE ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4619
Mailing Address - Country:US
Mailing Address - Phone:740-396-9783
Mailing Address - Fax:740-389-4835
Practice Address - Street 1:409 NYE ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-4619
Practice Address - Country:US
Practice Address - Phone:740-396-9783
Practice Address - Fax:740-389-4835
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.017561-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician