=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386188258
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PYCRAFT FAMILY EYE CARE LTD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2016
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 470 E MILLTOWN RD APT B
-----------------------------------------------------
City | WOOSTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44691-1250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-601-0393
-----------------------------------------------------
Fax | 330-601-0394
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 966 BUCHOLZ DR
-----------------------------------------------------
City | WOOSTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44691-2618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPTOMETRIST
-----------------------------------------------------
Name | DR. SCOTT PYCRAFT
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 330-601-0393
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 6096
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------