Provider Demographics
NPI:1164216172
Name:ANWAY, LOGAN
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:ANWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 N LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8870
Mailing Address - Country:US
Mailing Address - Phone:614-793-0700
Mailing Address - Fax:
Practice Address - Street 1:265 N LIBERTY ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8870
Practice Address - Country:US
Practice Address - Phone:614-793-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHOPT.007379152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program