Provider Demographics
NPI:1568412955
Name:OLENTANGY EYE AND LASER ASSOCIATES, INC.
Entity Type:Organization
Organization Name:OLENTANGY EYE AND LASER ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-267-4122
Mailing Address - Street 1:3794 OLENTANGY RIVER RD.
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3455
Mailing Address - Country:US
Mailing Address - Phone:614-267-4122
Mailing Address - Fax:614-267-4242
Practice Address - Street 1:3794 OLENTANGY RIVER RD.
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3455
Practice Address - Country:US
Practice Address - Phone:614-267-4122
Practice Address - Fax:614-267-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2048573Medicaid
OH2048573Medicaid