Provider Demographics
NPI:1831290626
Name:COLBY-AXE, CYNTHIA (OD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:
Last Name:COLBY-AXE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MEAD DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-3736
Mailing Address - Country:US
Mailing Address - Phone:740-772-2169
Mailing Address - Fax:
Practice Address - Street 1:256 N WOODBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2245
Practice Address - Country:US
Practice Address - Phone:740-773-4950
Practice Address - Fax:740-773-4965
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3392152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0475749Medicaid
OHCO0491501Medicare ID - Type Unspecified
OHT47260Medicare UPIN