Provider Demographics
NPI:1619160991
Name:NORTHWEST OPHTHALMOLOGY CENTER, INC.
Entity Type:Organization
Organization Name:NORTHWEST OPHTHALMOLOGY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:KEGLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-777-3937
Mailing Address - Street 1:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-0150
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3535 FISHINGER BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7504
Practice Address - Country:US
Practice Address - Phone:614-777-3937
Practice Address - Fax:614-777-4190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9347754Medicare PIN
OH9347751Medicare PIN