Provider Demographics
NPI:1548207582
Name:LEMBACH, MICHAEL E (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:LEMBACH
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 1:2250 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
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2020-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5265T2172152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH180015092OtherRR MEDICARE
OH2520089Medicaid
OH000000342600OtherANTHEM BC BS
OH0351310001OtherDMERC REGION B
OH297361049006OtherMEDICAL MUTUAL
OH180015092OtherRR MEDICARE
OHLE4138311Medicare ID - Type Unspecified