Provider Demographics
NPI:1831899087
Name:SEALS, RHONDA SUE
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:SUE
Last Name:SEALS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 GEORGESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-3327
Mailing Address - Country:US
Mailing Address - Phone:614-209-4454
Mailing Address - Fax:614-275-9847
Practice Address - Street 1:1221 GEORGESVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-3327
Practice Address - Country:US
Practice Address - Phone:614-209-4454
Practice Address - Fax:614-275-9847
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4075S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4075SMedicaid