Provider Demographics
NPI:1295999779
Name:RICHARD J VESLER O.D., INC
Entity type:Organization
Organization Name:RICHARD J VESLER O.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MNGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-878-1354
Mailing Address - Street 1:5109 WEST BROAD ST
Mailing Address - Street 2:STE 200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228
Mailing Address - Country:US
Mailing Address - Phone:614-878-1354
Mailing Address - Fax:614-878-8802
Practice Address - Street 1:5109 WEST BROAD ST
Practice Address - Street 2:STE 200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228
Practice Address - Country:US
Practice Address - Phone:614-878-1354
Practice Address - Fax:614-878-8802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0216644Medicaid
OHVE0392061Medicare PIN
OHT46590Medicare UPIN
OH0498070001Medicare NSC