Provider Demographics
NPI:1740268150
Name:ROMER, JON T (OD)
Entity type:Individual
Prefix:DR
First Name:JON
Middle Name:T
Last Name:ROMER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 HAVEMANN RD
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822-9300
Mailing Address - Country:US
Mailing Address - Phone:419-584-0615
Mailing Address - Fax:419-584-0637
Practice Address - Street 1:1950 HAVEMANN RD
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-9300
Practice Address - Country:US
Practice Address - Phone:419-584-0615
Practice Address - Fax:419-584-0637
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4871152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2103164Medicaid
OHU67733Medicare UPIN
OH0832963Medicare PIN