MEDICARE: DR. GEORGE PHILLIP VERLICH O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3158	OH

General Provider Information

NPI Number	:	1073664447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE PHILLIP VERLICH O.D.

Provider Business Mailing Address
First Line	:	7129 JOSEPHINE DR
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-5003
Country	:	US
Telephone Number	:	440-235-4026
Fax Number	:

Provider Business Practice Location Address
First Line	:	5000 GREAT NORTHERN MALL
Second Line	:
City	:	NORTH OLMSTED
State	:	OH
Zip	:	44070-3303
Country	:	US
Telephone Number	:	440-777-8168
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2007
Last Update Date	:	07/08/2007

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