Provider Demographics
NPI:1639179070
Name:BUCKLAND, ERIC ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:ROBERT
Last Name:BUCKLAND
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 1:4982 LONGMEAD DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9817
Mailing Address - Country:US
Mailing Address - Phone:614-871-9183
Mailing Address - Fax:614-539-8644
Practice Address - Street 1:1693 STRINGTOWN RD
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-8265
Practice Address - Country:US
Practice Address - Phone:614-539-8640
Practice Address - Fax:614-539-8644
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5377152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4121331Medicare PIN
OHU97536Medicare UPIN