Healthcare Provider Details

I. General information

NPI: 1265462881
Provider Name (Legal Business Name): WOOSTER OPHTHALMOLOGISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3519 FRIENDSVILLE RD
WOOSTER OH
44691-1241
US

IV. Provider business mailing address

3519 FRIENDSVILLE RD
WOOSTER OH
44691-1241
US

V. Phone/Fax

Practice location:
  • Phone: 330-345-7200
  • Fax: 330-345-8029
Mailing address:
  • Phone: 330-345-7200
  • Fax: 330-345-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberID#0374AS
License Number StateOH

VIII. Authorized Official

Name: JEFFREY W PERKINS
Title or Position: CEO
Credential: M.D.
Phone: 330-345-7200