| |
6790 Providence St, Whitehouse, OH 43571 | |
(419) 877-1188 | |
(419) 877-1156 |
Full Name | |
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Type | Facility |
Speciality | Optometrist |
Location | 6790 Providence St, Whitehouse, Ohio |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1164642435 | NPI | - | NPPES |
2196672 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | OH5163 (Ohio) | Primary |
Mailing Address | Practice Location Address |
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109 W Wayne St, Maumee, OH 43537-2150 Ph: (419) 893-6841 | 6790 Providence St, Whitehouse, OH 43571 Ph: (419) 877-1188 |