Basic Information
| Provider Information | |||||||||
| NPI: | 1285019679 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYBARGER | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | ERIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 553 E. TOWN ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432154925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144611885 | ||||||||
| FaxNumber: | 6144615730 | ||||||||
| Practice Location | |||||||||
| Address1: | 553 E TOWN ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432154927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144611885 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2015 | ||||||||
| LastUpdateDate: | 07/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | OPT.6387 | OH | Y | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management |
No ID Information.