Provider Demographics
NPI:1891139176
Name:GERALD R. PAGE, O.D., INC.
Entity Type:Organization
Organization Name:GERALD R. PAGE, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-457-1159
Mailing Address - Street 1:1906 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-1864
Mailing Address - Country:US
Mailing Address - Phone:614-457-1159
Mailing Address - Fax:614-457-2429
Practice Address - Street 1:1906 BETHEL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-1864
Practice Address - Country:US
Practice Address - Phone:614-457-1159
Practice Address - Fax:614-457-2429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3367T586305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0503002Medicare PIN