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General NPI Number Information
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NPI Number | 1588876635
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Entity Type | Organization
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Legal Business Name | NORTHWEST EYECARE, LLC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 03/09/2012
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Provider Practice Location Address
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Address Line | 132 N FULTON ST
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City | WAUSEON
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State | OH
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Zip | 43567-1353
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Country | US
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Telephone | 419-337-6371
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Fax | 419-337-6300
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Provider Business Mailing Address
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Address Line | PO BOX 395
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City | WAUSEON
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State | OH
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Zip | 43567-0395
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Country | US
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Telephone | 419-337-6371
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Fax | 419-337-6300
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Authorized Official
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Title or Position | OWNER
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Name | DR. STANLEY L. DARNELL
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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 | 3714 T858
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License Number State | OH
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