Provider Demographics
NPI:1427182344
Name:NORTHWEST OPTICAL
Entity Type:Organization
Organization Name:NORTHWEST OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEMBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-451-7550
Mailing Address - Street 1:2250 N BANK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-5420
Mailing Address - Country:US
Mailing Address - Phone:614-451-7550
Mailing Address - Fax:614-451-8642
Practice Address - Street 1:2250 N BANK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-5420
Practice Address - Country:US
Practice Address - Phone:614-451-7550
Practice Address - Fax:614-451-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCC5840OtherRR MEDICARE
OH0698606Medicaid
OH0351310001Medicare NSC