Healthcare Provider Details

I. General information

NPI: 1013337872
Provider Name (Legal Business Name): AMEDCO OHIO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 04/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NILES CORTLAND RD SE
WARREN OH
44484-3042
US

IV. Provider business mailing address

2200 NILES CORTLAND RD SE
WARREN OH
44484-3042
US

V. Phone/Fax

Practice location:
  • Phone: 330-544-9434
  • Fax: 330-544-9433
Mailing address:
  • Phone: 330-544-9434
  • Fax: 330-544-9433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MS. ERICA PERREIRA
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 877-881-0022