Organization
KIP NEWELL OD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY NEWELL (OFFICE MANAGER)
(419) 209-0540
Entity
Organization
Contact information
Practice address
131 W WYANDOT AVE, UPPER SANDUSKY, OH 43351-1348
(419) 209-0540
(419) 209-0540
Mailing address
131 W WYANDOT AVE, UPPER SANDUSKY, OH 43351-1348
(419) 209-0540
(419) 209-0540
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4617 T1363
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3135986
—
OH
Enumeration date
11/29/2007
Last updated
05/07/2011
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