1184605180 NPI number — DR. ROBERT F. KOERNER O.D.

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	KOERNER
Provider First Name	:	ROBERT
Provider Middle Name	:	F.
Provider Name Prefix Text	:	DR.
Provider Name Suffix Text	:
Provider Credential Text	:	O.D.
Provider Gender Code	:	M

Provider Other Organization Name	:
Provider Other Organization Name Type Code	:
Provider Other Last Name	:
Provider Other First Name	:
Provider Other Middle Name	:
Provider Other Name Prefix Text	:
Provider Other Name Suffix Text	:
Provider Other Credential Text	:
Provider Other Last Name Type Code	:

NPI Number	:	1184605180
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	07/15/2008
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
NPI Reactivation Date	:

Provider First Line Business Mailing Address	:	553 E TOWN ST
Provider Second Line Business Mailing Address	:
Provider Business Mailing Address City Name	:	COLUMBUS
Provider Business Mailing Address State Name	:	OH
Provider Business Mailing Address Postal Code	:	432154856
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	6144611885
Provider Business Mailing Address Fax Number	:	6144615730

Provider First Line Business Practice Location Address	:	553 E TOWN ST
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	COLUMBUS
Provider Business Practice Location Address State Name	:	OH
Provider Business Practice Location Address Postal Code	:	432154856
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	6144611885
Provider Business Practice Location Address Fax Number	:	6144615730
Provider Enumeration Date	:	11/08/2005

Authorized Official Last Name	:
Authorized Official First Name	:
Authorized Official Middle Name	:
Authorized Official Title or Position	:
Authorized Official Telephone Number	:

• Taxonomy code: 152W00000X , with the licence number:  4363 , registered in the state of OH .

• Identifier: 4245430001 , issued by the state of ( OH ) . This identifiers is of the category "".
• Identifier: PR9297781 , issued by the state of ( OH ) . This identifiers is of the category "".
• Identifier: 0995151 , issued by the state of ( OH ) . This identifiers is of the category "".
• Identifier: KO0778433 , issued by the state of ( OH ) . This identifiers is of the category "".
• Identifier: U56311 , issued by the state of ( OH ) . This identifiers is of the category "".