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General NPI Number Information
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NPI Number | 1083027346
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Entity Type | Individual
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Provider Name | DUSTIN JEFFREY WASYLIK D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 5655 MONCLOVA RD
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City | MAUMEE
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State | OH
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Zip | 43537-1870
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Country | US
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Telephone | 419-357-3359
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Fax |
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Provider Business Mailing Address
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Address Line | 363 ARROWHEAD DR
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City | PERRYSBURG
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State | OH
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Zip | 43551-6355
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Country | US
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Telephone | 419-357-3359
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 293780
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 81143
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License Number State | WI
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