Healthcare Provider Details

I. General information

NPI: 1750296703
Provider Name (Legal Business Name): MELISSA WODRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 N STATE ROUTE 53
FREMONT OH
43420-8628
US

IV. Provider business mailing address

2052 N STATE ROUTE 53
FREMONT OH
43420-8628
US

V. Phone/Fax

Practice location:
  • Phone: 419-334-7353
  • Fax: 419-334-7844
Mailing address:
  • Phone: 419-334-7353
  • Fax: 419-334-7844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberOP.018009-S
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: