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General NPI Number Information
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NPI Number | 1376643445
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Entity Type | Individual
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Provider Name | DOUGLAS J WINE OD
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 09/29/2010
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Provider Practice Location Address
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Address Line | 140 W SPRING ST
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City | SAINT MARYS
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State | OH
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Zip | 45885-2312
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Country | US
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Telephone | 419-394-2397
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Fax | 419-394-2398
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Provider Business Mailing Address
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Address Line | 140 W SPRING ST
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City | SAINT MARYS
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State | OH
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Zip | 45885-2312
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Country | US
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Telephone | 419-394-2397
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Fax | 419-394-2398
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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 | 3979
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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 | T1670
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License Number State | OH
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