MEDICARE: OAKWOOD EYE CLINIC

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	332B00000X	Durable Medical Equipment & Medical Supplies	3639 T	OH

General Provider Information

NPI Number	:	1679765994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAKWOOD EYE CLINIC

Provider Business Mailing Address
First Line	:	2525 FAR HILLS AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-1505
Country	:	US
Telephone Number	:	937-298-0550
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 FAR HILLS AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45419-1505
Country	:	US
Telephone Number	:	937-298-0550
Fax Number	:

Authorized Official
Title or Position	:	PHYSCIAN OWNER
Name	:	DR. PARK ALAN STUDEBAKER
Credential	:	O.D.
Telephone Number	:	937-298-0550

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	06/17/2008

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Directions to “OAKWOOD EYE CLINIC ” Practice Location

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