Provider Demographics
NPI:1568736023
Name:INDEPENDENT DOCTORS OF OPTOMETRY, LLC
Entity Type:Organization
Organization Name:INDEPENDENT DOCTORS OF OPTOMETRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROZZO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-893-1165
Mailing Address - Street 1:995 KENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-4122
Mailing Address - Country:US
Mailing Address - Phone:614-893-1165
Mailing Address - Fax:
Practice Address - Street 1:2687 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1670
Practice Address - Country:US
Practice Address - Phone:740-687-0530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3822152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty