Provider Demographics
NPI:1689846214
Name:DUBOIS OPTICAL
Entity Type:Organization
Organization Name:DUBOIS OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:513-421-2911
Mailing Address - Street 1:645 WALNUT STREET
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202
Mailing Address - Country:US
Mailing Address - Phone:513-421-2911
Mailing Address - Fax:
Practice Address - Street 1:645 WALNUT ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-2516
Practice Address - Country:US
Practice Address - Phone:513-421-2911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4729SC332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0374812Medicaid