MEDICARE: NORTHWEST OPTOMETRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	3970	OH
2	152W00000X	Optometrist	3970	OH

General Provider Information

NPI Number	:	1316004187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST OPTOMETRY LLC

Provider Business Mailing Address
First Line	:	639 W NATIONAL RD
Second Line	:
City	:	ENGLEWOOD
State	:	OH
Zip	:	45322-1155
Country	:	US
Telephone Number	:	937-836-3041
Fax Number	:	937-836-1937

Provider Business Practice Location Address
First Line	:	639 W NATIONAL RD
Second Line	:
City	:	ENGLEWOOD
State	:	OH
Zip	:	45322-1155
Country	:	US
Telephone Number	:	937-836-3041
Fax Number	:	937-836-1937

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. JOSEPH STUDEBAKER
Credential	:	O.D.
Telephone Number	:	937-836-3041

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	10/14/2015

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Directions to “NORTHWEST OPTOMETRY LLC ” Practice Location

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