MEDICARE: EMILY P AMWEG OD

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	6533	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356879910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY P AMWEG OD

Provider Business Mailing Address
First Line	:	466 S TRIMBLE RD
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44906-3416
Country	:	US
Telephone Number	:	419-756-8000
Fax Number	:	419-756-2601

Provider Business Practice Location Address
First Line	:	58 W HIGH ST
Second Line	:
City	:	MOUNT GILEAD
State	:	OH
Zip	:	43338-1213
Country	:	US
Telephone Number	:	419-756-8000
Fax Number	:	419-947-8355

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

Provider Enumeration Date	:	05/26/2017
Last Update Date	:	07/21/2022

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