Provider Demographics
NPI:1912005398
Name:EDDLEBLUTE, MOLLY M (OD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:M
Last Name:EDDLEBLUTE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MOLLY
Other - Middle Name:M
Other - Last Name:LESCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4555 CEMETERY RD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1102
Mailing Address - Country:US
Mailing Address - Phone:614-876-4044
Mailing Address - Fax:
Practice Address - Street 1:4555 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1102
Practice Address - Country:US
Practice Address - Phone:614-876-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5632152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2682146Medicaid
OHV10127Medicare UPIN
OH2682146Medicaid