Provider Demographics
NPI:1871758292
Name:VARGO, JANNA L (OD)
Entity type:Individual
Prefix:MRS
First Name:JANNA
Middle Name:L
Last Name:VARGO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 AGLER ROAD
Mailing Address - Street 2:SUITE 2300 - BILLING DEPT.
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-3389
Mailing Address - Country:US
Mailing Address - Phone:614-859-1939
Mailing Address - Fax:614-458-1849
Practice Address - Street 1:2300 W BROAD ST
Practice Address - Street 2:2ND FLOOR WESTSIDE HEALTH CENTER VISION
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-3783
Practice Address - Country:US
Practice Address - Phone:614-859-1820
Practice Address - Fax:614-458-1192
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.5825-THER152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2904290Medicaid
OH2904290Medicaid
H080720Medicare PIN