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General NPI Number Information
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NPI Number | 1992984033
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Entity Type | Organization
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Legal Business Name | EYES 20/20
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 01/04/2011
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Provider Practice Location Address
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Address Line | 115 W BROAD ST SUITE A
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City | NEWTON FALLS
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State | OH
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Zip | 44444-1572
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Country | US
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Telephone | 330-872-1371
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Fax |
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Provider Business Mailing Address
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Address Line | 115 W BROAD ST SUITE A
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City | NEWTON FALLS
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State | OH
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Zip | 44444-1572
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Country | US
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Telephone | 330-872-1371
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD WALLIE
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Credential | OD
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Telephone | 330-872-1371
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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 | 3576
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License Number State | OH
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