Healthcare Provider Details

I. General information

NPI: 1760512388
Provider Name (Legal Business Name): RONALD WACHT OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 BRITTAIN RD STE 10
AKRON OH
44310-1813
US

IV. Provider business mailing address

147 GERTRUDE AVE
CAMPBELL OH
44405-2060
US

V. Phone/Fax

Practice location:
  • Phone: 330-633-3556
  • Fax:
Mailing address:
  • Phone: 330-774-3676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000203
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT001415
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4499T1155
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: