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General NPI Number Information
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NPI Number | 1689931784
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Entity Type | Organization
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Legal Business Name | J. EDGAR EVANS O.D., INC.
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Dates
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Enumeration Date | 04/13/2012
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Last Update Date | 04/13/2012
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Provider Practice Location Address
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Address Line | 11 S PENNSYLVANIA AVE
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City | WELLSTON
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State | OH
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Zip | 45692-1255
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Country | US
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Telephone | 740-384-2015
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Fax | 740-384-5634
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Provider Business Mailing Address
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Address Line | 11 S PENNSYLVANIA AVE
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City | WELLSTON
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State | OH
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Zip | 45692-1255
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Country | US
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Telephone | 740-384-2015
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Fax | 740-384-5634
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SHIRLENE SHERWOOD
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Credential |
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Telephone | 740-384-2015
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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 | 2942/T1049
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License Number State | OH
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