Basic Information
| Provider Information | |||||||||
| NPI: | 1023069515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OPHTHALMIC ANESTHESIA ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | L-3800 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432603800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6147611255 | ||||||||
| FaxNumber: | 6145520168 | ||||||||
| Practice Location | |||||||||
| Address1: | 262 NEIL AVE STE 500 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432157313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148276600 | ||||||||
| FaxNumber: | 6148276690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | DOWLING | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6148276600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | CA4465 | 01 | MEDICARE RAILROAD | OTHER | 0628226 | 05 | OH | MEDICAID |