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General NPI Number Information
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NPI Number | 1306847157
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Entity Type | Individual
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Provider Name | WILLIAM KEGERIZE OD
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Gender | Male
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Dates
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Enumeration Date | 08/02/2005
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Last Update Date | 01/15/2019
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Provider Practice Location Address
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Address Line | 603 MAIN ST
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City | GENOA
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State | OH
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Zip | 43430-1635
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Country | US
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Telephone | 419-855-3640
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Fax | 419-855-4743
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Provider Business Mailing Address
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Address Line | 1606 DIER RD
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City | CURTICE
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State | OH
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Zip | 43412-9702
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Country | US
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Telephone |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 5558
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License Number State | OH
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