Provider Demographics
NPI:1831118363
Name:EPSTEIN, AVROM DAVID (MD)
Entity Type:Individual
Prefix:
First Name:AVROM
Middle Name:DAVID
Last Name:EPSTEIN
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
Mailing Address - Street 2:SUITE 440
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7309
Mailing Address - Country:US
Mailing Address - Phone:614-221-4166
Mailing Address - Fax:614-221-5524
Practice Address - Street 1:262 NEIL AVE
Practice Address - Street 2:SUITE 440
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215
Practice Address - Country:US
Practice Address - Phone:614-221-4166
Practice Address - Fax:614-221-5524
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067301207WX0109X
OH35-06-7301-E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH180028186OtherRAILROAD MEDICARE #
OH000000115552OtherANTHEM PROVIDER ID#
OH0739624Medicaid
OH0739624Medicaid