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NPI Code Detail

MEDICARE: ANGELA GREENSLAIT O.D.

MEDICARE: ANGELA GREENSLAIT 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
1152W00000XOptometristOH4720OH

General Provider Information

NPI Number : 1891862272
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANGELA GREENSLAIT O.D.
Provider Business Mailing Address
First Line : PO BOX 496
Second Line : SUITE 2012
City : LEWIS CENTER
State : OH
Zip : 43035-0496
Country : US
Telephone Number : 614-477-1670
Fax Number :
Provider Business Practice Location Address
First Line : 1558 COSHOCTON AVE
Second Line : STE C
City : MOUNT VERNON
State : OH
Zip : 43050-5416
Country : US
Telephone Number : 614-880-9196
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/29/2006
Last Update Date : 11/10/2016

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