Healthcare Provider Details

I. General information

NPI: 1235274341
Provider Name (Legal Business Name): HEALTH SPECIALISTS OF DAYTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 SUGAR CAMP CIR
DAYTON OH
45409-1962
US

IV. Provider business mailing address

105 SUGAR CAMP CIR
DAYTON OH
45409-1962
US

V. Phone/Fax

Practice location:
  • Phone: 937-222-3937
  • Fax: 937-223-5416
Mailing address:
  • Phone: 937-222-3937
  • Fax: 937-223-5416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH J PRUNIER
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 937-208-8252