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General NPI Number Information
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NPI Number | 1538536982
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Entity Type | Organization
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Legal Business Name | WAUSEON EYE CARE, LLC
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Dates
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Enumeration Date | 09/01/2015
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 474 AIRPORT HWY
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City | WAUSEON
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State | OH
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Zip | 43567-9791
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Country | US
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Telephone | 419-337-6371
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 302
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City | WAUSEON
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State | OH
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Zip | 43567-0302
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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 | MANAGING MEMBER
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Name | DR. JOHN STEHULAK
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Credential | O.D.
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Telephone | 419-337-6371
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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 |
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License Number State |
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