Provider Demographics
NPI:1396822334
Name:AVROM D. EPSTEIN
Entity Type:Organization
Organization Name:AVROM D. EPSTEIN
Other - Org Name:CENTRAL OHIO NEURO OPHTHALMOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVROM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:EPSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-221-4166
Mailing Address - Street 1:262 NEIL AVE
Mailing Address - Street 2:SUITE 440
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7309
Mailing Address - Country:US
Mailing Address - Phone:614-221-4166
Mailing Address - Fax:614-221-5524
Practice Address - Street 1:262 NEIL AVE
Practice Address - Street 2:SUITE 440
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7309
Practice Address - Country:US
Practice Address - Phone:614-221-4166
Practice Address - Fax:614-221-5524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067301261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCE9285391Medicare ID - Type UnspecifiedMDCR GROUP ID