Healthcare Provider Details

I. General information

NPI: 1841307675
Provider Name (Legal Business Name): CANTON OPTOMETRY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4865 FRANK AVE NW
NORTH CANTON OH
44720-7425
US

IV. Provider business mailing address

4865 FRANK AVE NW
NORTH CANTON OH
44720-7425
US

V. Phone/Fax

Practice location:
  • Phone: 330-494-1710
  • Fax: 330-494-5815
Mailing address:
  • Phone: 330-494-1710
  • Fax: 330-494-5815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. WILLIAM SHENDELAS
Title or Position: DOCTOR
Credential: O.D.
Phone: 330-494-1710