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General NPI Number Information
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NPI Number | 1669640124
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Entity Type | Organization
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Legal Business Name | WADSWORTH EYE CLINIC, INC
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Dates
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Enumeration Date | 02/18/2008
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Last Update Date | 05/12/2021
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Provider Practice Location Address
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Address Line | 1197 HIGH ST STE 106
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City | WADSWORTH
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State | OH
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Zip | 44281-8282
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Country | US
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Telephone | 330-247-2480
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Fax | 330-336-0099
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Provider Business Mailing Address
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Address Line | 1197 HIGH ST STE 106
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City | WADSWORTH
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State | OH
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Zip | 44281-8282
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Country | US
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Telephone | 330-247-2480
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Fax | 330-336-0099
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Authorized Official
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Title or Position | OWNER
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Name | DR. RACHEL A BIEDENBACH
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Credential | M.D.
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Telephone | 330-247-2480
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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 | 5652
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 35085999
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License Number State | OH
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