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General NPI Number Information
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NPI Number | 1922123215
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Entity Type | Organization
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Legal Business Name | PRUSINSKI EYE CARE, INC.
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2214 RICHLAND MALL
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City | MANSFIELD
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State | OH
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Zip | 44906-1249
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Country | US
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Telephone | 419-529-5770
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Fax |
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Provider Business Mailing Address
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Address Line | 5440 BROOK RUN DR
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City | MEDINA
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State | OH
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Zip | 44256-6442
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Country | US
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Telephone | 330-725-7618
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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. ANTHONY M PRUSINSKI
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Credential | O.D.
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Telephone | 330-725-7618
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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 | 4978 T1848
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License Number State | OH
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