Provider Demographics
NPI:1629169065
Name:DINGLE, JACK (MD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:DINGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 NEIL AVE STE 420
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7312
Mailing Address - Country:US
Mailing Address - Phone:614-224-4297
Mailing Address - Fax:614-224-5668
Practice Address - Street 1:262 NEIL AVE STE 420
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7312
Practice Address - Country:US
Practice Address - Phone:614-224-4297
Practice Address - Fax:614-224-5668
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.034836207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4459708OtherAETNA
OH0139951Medicaid
OH4471296004OtherCIGNA
OH000000116910OtherANTHEM BC BS
OH0800048OtherUNITED HEALTHCARE
OH4459708OtherAETNA
OH0139951Medicaid