Healthcare Provider Details

I. General information

NPI: 1033391958
Provider Name (Legal Business Name): WAYNESBURG VISION CARE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8163 WAYNESBURG DR. SE
WAYNESBURG OH
44688
US

IV. Provider business mailing address

PO BOX 447
WAYNESBURG OH
44688-0447
US

V. Phone/Fax

Practice location:
  • Phone: 330-866-7732
  • Fax: 330-866-4069
Mailing address:
  • Phone: 330-866-7732
  • Fax: 330-866-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4749
License Number StateOH

VIII. Authorized Official

Name: DR. BRADEN E KAIL
Title or Position: CEO
Credential: O.D.
Phone: 330-866-7732