Provider Demographics
NPI:1770547960
Name:FOX, ANTHONY EDWARD (OD, MS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:EDWARD
Last Name:FOX
Suffix:
Gender:M
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 E COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2001
Mailing Address - Country:US
Mailing Address - Phone:937-592-9777
Mailing Address - Fax:
Practice Address - Street 1:315 E COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2001
Practice Address - Country:US
Practice Address - Phone:937-592-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK237152W00000X
OH5471 T2383152W00000X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHV01126Medicare UPIN
OHH195550Medicare PIN
OH0560960001Medicare NSC
OH0560960002Medicare NSC
OH4141122Medicare PIN