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Individual

DR. LAIRD DOUGLAS ACKERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
4555 CEMETERY RD, HILLIARD, OH 43026-1102
(614) 876-4044
(614) 876-0255
Mailing address
4555 CEMETERY RD, HILLIARD, OH 43026-1102
(614) 876-4044
(614) 876-0255

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3586/T1086
OH
152WC0802X
Corneal and Contact Management Optometrist
3586/T1086
OH
152WP0200X
Pediatric Optometrist
3586/T1086
OH
152WS0006X
Sports Vision Optometrist
3586/T1086
OH
152WV0400X
Vision Therapy Optometrist
3586/T1086
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000323515
ANTHEM BC/BS PROVIDER
OH
01
04-3743736
FED TAX ID
OH
01
2200005
UNITED HEATHCARE PROVIDER
OH
01
DE3942
RAILROAD MEDICARE GRP NO.
OH
01
P00289883
RAILROAD MEDICARE B PIN
OH
Enumeration date
07/27/2006
Last updated
03/20/2009
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