MEDICARE: THOMAS WOYTTA INC.

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	4901002400	MI

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	:	1942292289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS WOYTTA INC.

Provider Business Mailing Address
First Line	:	1100 MICHIGAN AVE
Second Line	:
City	:	MARYSVILLE
State	:	MI
Zip	:	48040-2112
Country	:	US
Telephone Number	:	810-364-1334
Fax Number	:	810-364-1075

Provider Business Practice Location Address
First Line	:	1100 MICHIGAN AVE
Second Line	:
City	:	MARYSVILLE
State	:	MI
Zip	:	48040-2112
Country	:	US
Telephone Number	:	810-364-1334
Fax Number	:	810-364-1075

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS WOYTTA
Credential	:	O.D.
Telephone Number	:	810-364-1334

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	12/28/2009

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