Healthcare Provider Details

I. General information

NPI: 1295860559
Provider Name (Legal Business Name): GUNNING AMES PTRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 E NORTH ST
WAVERLY OH
45690-1148
US

IV. Provider business mailing address

218 E NORTH ST
WAVERLY OH
45690-1148
US

V. Phone/Fax

Practice location:
  • Phone: 740-947-2945
  • Fax: 740-947-1458
Mailing address:
  • Phone: 740-947-2945
  • Fax: 740-947-1458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: JOHN N GUNNING II
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 740-947-2945