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General NPI Number Information
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NPI Number | 1578794475
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Entity Type | Individual
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Provider Name | THERESA MARIE AYERS
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Gender | Female
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Dates
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Enumeration Date | 07/27/2009
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Last Update Date | 07/27/2009
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Provider Practice Location Address
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Address Line | 18054 ROYALTON RD
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City | STRONGSVILLE
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State | OH
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Zip | 44136-5180
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Country | US
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Telephone | 440-268-0765
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Fax | 440-268-0857
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Provider Business Mailing Address
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Address Line | 5766 HUCKLEBERRY ST NW
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City | NORTH CANTON
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State | OH
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Zip | 44720-6706
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Country | US
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Telephone | 330-806-2312
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Fax | 330-296-7780
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | 4032-S
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License Number State | OH
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