Provider Demographics
NPI:1376703850
Name:JAMES L EDICK OD LLC
Entity Type:Organization
Organization Name:JAMES L EDICK OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LAURENCE
Authorized Official - Last Name:EDICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-430-8964
Mailing Address - Street 1:6116 BOARDWALK ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229
Mailing Address - Country:US
Mailing Address - Phone:614-430-8964
Mailing Address - Fax:614-430-8965
Practice Address - Street 1:6116 BOARDWALK ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229
Practice Address - Country:US
Practice Address - Phone:614-430-8964
Practice Address - Fax:614-430-8965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0606126Medicare PIN
OHT 48669Medicare UPIN