Provider Demographics
NPI:1558513317
Name:DR DAVID A. NIEDERKOHR INC.
Entity Type:Organization
Organization Name:DR DAVID A. NIEDERKOHR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIEDERKOHR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:740-369-7701
Mailing Address - Street 1:10197 ABBOTTS WAY
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-6652
Mailing Address - Country:US
Mailing Address - Phone:614-785-9858
Mailing Address - Fax:
Practice Address - Street 1:25 NORTHWOOD DR
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1501
Practice Address - Country:US
Practice Address - Phone:740-369-7701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3260T1062152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0152220001Medicare NSC
OHH087960Medicare PIN