Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | OH3303 | OH |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 3303 T964 | OH |
NPI | 1134299704 |
---|---|
Provider Name | Dr. Michael John Rader |
First Address | Hilliard, OH 43026-7406 |
Second Address | Hilliard, OH 43026-7406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 08/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0366152 | (05) | OH |
410002935 | RAILROAD MEDICARE (01) | OH |
T47165 | (02) | OH |