Healthcare Provider Details

I. General information

NPI: 1871912410
Provider Name (Legal Business Name): PROMEDICA CENTRAL PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 MONROE ST UNIT 211
SYLVANIA OH
43560-2737
US

IV. Provider business mailing address

100 MADISON AVE FL 3
TOLEDO OH
43604-1516
US

V. Phone/Fax

Practice location:
  • Phone: 419-776-1004
  • Fax: 419-776-1020
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: TANYA WINES
Title or Position: DIRECTOR
Credential:
Phone: 567-585-0422