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General NPI Number Information
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NPI Number | 1104223726
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Entity Type | Organization
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Legal Business Name | OPTICAL SOLUTIONS 3 LLC
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Dates
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Enumeration Date | 11/25/2014
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Last Update Date | 02/26/2016
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Provider Practice Location Address
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Address Line | 2658 NILES CORTLAND RD SE
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City | WARREN
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State | OH
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Zip | 44484-3871
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Country | US
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Telephone | 330-349-4690
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Fax | 330-349-4694
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Provider Business Mailing Address
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Address Line | 2658 NILES CORTLAND RD SE
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City | WARREN
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State | OH
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Zip | 44484-3871
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Country | US
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Telephone | 330-349-4690
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Fax | 330-349-4694
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | MR. RONALD L DETWILER
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Credential | O.D.
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Telephone | 330-349-4690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3166T1622
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License Number State | OH
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