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General NPI Number Information
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NPI Number | 1821538588
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Entity Type | Organization
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Legal Business Name | BOUSCHER FAMILY EYE CARE, INC.
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Dates
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Enumeration Date | 02/28/2017
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Last Update Date | 02/28/2017
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Provider Practice Location Address
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Address Line | 222 E SMOKERISE DR
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City | WADSWORTH
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State | OH
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Zip | 44281-8277
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Country | US
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Telephone | 330-336-5301
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Fax |
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Provider Business Mailing Address
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Address Line | 652 REIMER RD
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City | WADSWORTH
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State | OH
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Zip | 44281-8429
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Country | US
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Telephone | 330-336-5301
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KAREN BOUSCHER
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Credential | O.D.
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Telephone | 330-336-5301
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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 | 4426T1017
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License Number State | OH
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