Healthcare Provider Details

I. General information

NPI: 1679651640
Provider Name (Legal Business Name): JOSEPH D SCHWALLIE OD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7121 ORCHARD CENTRE DR
HOLLAND OH
43528-7975
US

IV. Provider business mailing address

7121 ORCHARD CENTRE DR
HOLLAND OH
43528-7975
US

V. Phone/Fax

Practice location:
  • Phone: 419-865-7125
  • Fax:
Mailing address:
  • Phone: 419-865-7125
  • Fax: 419-865-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4232
License Number StateOH

VIII. Authorized Official

Name: JOE D SCHWALLIE
Title or Position: PRESIDENT
Credential: OD
Phone: 419-865-7125