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General NPI Number Information
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NPI Number | 1871647230
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Entity Type | Individual
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Provider Name | TED A RATH OD
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Gender | Male
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 11/05/2008
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Provider Practice Location Address
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Address Line | 1174 ALLIANCE ROAD
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City | MINERVA
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State | OH
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Zip | 44657
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Country | US
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Telephone | 330-868-0076
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Fax | 330-868-4096
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Provider Business Mailing Address
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Address Line | 1174 ALLIANCE RD NW
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City | MINERVA
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State | OH
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Zip | 44657-8736
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Country | US
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Telephone | 330-868-0076
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Fax | 330-868-4096
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4308T212
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License Number State | OH
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