Provider Demographics
NPI:1346214848
Name:BOSNER, DOUGLAS JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JOSEPH
Last Name:BOSNER
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 1:2098 TREMONT CTR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3108
Mailing Address - Country:US
Mailing Address - Phone:614-486-5205
Mailing Address - Fax:614-486-0354
Practice Address - Street 1:2098 TREMONT CTR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3108
Practice Address - Country:US
Practice Address - Phone:614-486-5205
Practice Address - Fax:614-486-0354
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS291152W00000X
OHT2200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2408460Medicaid
OH000000356306OtherANTHEM
U95683Medicare UPIN
OH2408460Medicaid