Provider Demographics
NPI:1376716514
Name:PICKERING, LUCY (OD)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:
Last Name:PICKERING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1105
Mailing Address - Country:US
Mailing Address - Phone:614-395-2957
Mailing Address - Fax:
Practice Address - Street 1:126 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1105
Practice Address - Country:US
Practice Address - Phone:614-395-2957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5671152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4289301OtherMEDICARE IDENTIFICATION NUMBER