MEDICARE: DR. RICHARD E WYSZYNSKI M.D.

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	35-054663-W	OH
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	35.054663	OH

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	180011157	OTHER	OH	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80523	OTHER	OH	QUALCHOICE
2	0800331	OTHER	OH	UNITED HEALTHCARE
4	574789	OTHER	OH	KEYSTONE
5	M54663	OTHER	OH	SUMMACARE
6	4125776	OTHER	OH	AETNA
7	000000126323	OTHER	OH	ANTHEM
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1134121577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD E WYSZYNSKI M.D.

Provider Business Mailing Address
First Line	:	4676 DOUGLAS CIR NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-3619
Country	:	US
Telephone Number	:	330-494-1116
Fax Number	:	330-494-0276

Provider Business Practice Location Address
First Line	:	4676 DOUGLAS CIR NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-3619
Country	:	US
Telephone Number	:	330-494-1116
Fax Number	:	330-494-0276

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	06/02/2021

2050 CUMMING HWY , SUITE 100
CANTON, GA
30114-8614

Practice Phone: 770-345-9600
Practice Fax: