Provider Demographics
NPI:1568444354
Name:DENNIS, PAUL E (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:DENNIS
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 1:120 N HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2602
Mailing Address - Country:US
Mailing Address - Phone:614-475-8134
Mailing Address - Fax:614-475-8326
Practice Address - Street 1:120 N HAMILTON RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2602
Practice Address - Country:US
Practice Address - Phone:614-475-8134
Practice Address - Fax:614-475-8326
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3936T042152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1308150001OtherDMERC SUPPLIER #
OH0287176Medicaid
OH1295717080Medicare PIN
OHU08693Medicare UPIN
OHDE0661634Medicare PIN
OH9308091Medicare PIN
OH0287176Medicaid