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General NPI Number Information
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NPI Number | 1164642435
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Entity Type | Organization
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Legal Business Name | DR PATRICK HENRY OD LLC
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 07/01/2008
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Provider Practice Location Address
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Address Line | 6790 PROVIDENCE ST
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City | WHITEHOUSE
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State | OH
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Zip | 43571
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Country | US
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Telephone | 419-877-1188
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Fax | 419-877-1156
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Provider Business Mailing Address
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Address Line | 109 W WAYNE ST
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City | MAUMEE
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State | OH
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Zip | 43537-2150
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Country | US
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Telephone | 419-893-6841
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Fax | 419-893-4894
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MRS. HOPE D WCISLAK
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Credential |
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Telephone | 419-824-3318
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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 | OH5163
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License Number State | OH
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