Organization
COURTNEY L POLING OD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. COURTNEY LYNN POLING OD (OWNER)
(937) 644-2075
Entity
Organization
Contact information
Practice address
303 W FIFTH ST, MARYSVILLE, OH 43040-0396
(937) 644-2075
(937) 644-2017
Mailing address
PO BOX 396, 303 W FIFTH ST, MARYSVILLE, OH 43040-0396
(937) 644-2075
(937) 644-2017
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2995T96
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C09327131
MEDICARE GROUP NUMBER
—
Enumeration date
10/30/2007
Last updated
10/30/2007
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