Provider Demographics
NPI:1831330976
Name:NORTHWEST EYECARE PROFESSIONALS LLC
Entity type:Organization
Organization Name:NORTHWEST EYECARE PROFESSIONALS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BOSNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-486-5205
Mailing Address - Street 1:2098 TREMONT CTR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3108
Mailing Address - Country:US
Mailing Address - Phone:614-486-5205
Mailing Address - Fax:614-486-0354
Practice Address - Street 1:2098 TREMONT CTR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3108
Practice Address - Country:US
Practice Address - Phone:614-486-5205
Practice Address - Fax:614-486-0354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5291 T2200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6355540001Medicare NSC
OHU95683Medicare UPIN
OHBO4109023Medicare PIN