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General NPI Number Information
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NPI Number | 1316004187
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Entity Type | Organization
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Legal Business Name | NORTHWEST OPTOMETRY LLC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 639 W NATIONAL RD
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City | ENGLEWOOD
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State | OH
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Zip | 45322-1155
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Country | US
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Telephone | 937-836-3041
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Fax | 937-836-1937
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Provider Business Mailing Address
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Address Line | 639 W NATIONAL RD
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City | ENGLEWOOD
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State | OH
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Zip | 45322-1155
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Country | US
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Telephone | 937-836-3041
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Fax | 937-836-1937
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JOSEPH STUDEBAKER
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Credential | O.D.
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Telephone | 937-836-3041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 3970
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3970
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License Number State | OH
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