Organization
WIZARD OF EYES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK DESMON ROUDEBUSH OD (PRESIDENT)
(614) 619-7973
Entity
Organization
Contact information
Practice address
9878 BREWSTER LN, BOX 108, POWELL, OH 43065-7980
(614) 619-7973
(614) 789-6399
Mailing address
2725 S HAMILTON RD, G-5, COLUMBUS, OH 43232-4904
(614) 863-0195
(614) 863-2701
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5771
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0102912
—
OH
Enumeration date
06/11/2014
Last updated
08/06/2014
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