Provider Demographics
NPI:1073537023
Name:COLLIER, WAYNE H (OD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:H
Last Name:COLLIER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 S POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-2663
Mailing Address - Country:US
Mailing Address - Phone:419-562-3822
Mailing Address - Fax:419-562-9939
Practice Address - Street 1:905 S POPLAR ST
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820-2663
Practice Address - Country:US
Practice Address - Phone:419-562-3822
Practice Address - Fax:419-562-9939
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2786152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0005635655OtherAETNA
OH0090299Medicaid
OH341116258027OtherCARESOURCE
OHOH2786OtherEYEMED
OHEO14678OtherSPECTERA
OH85394OtherCOLE VISION
OH000000127556OtherANTHEM
OH0005635655OtherAETNA
OH341116258027OtherCARESOURCE
OHEO14678OtherSPECTERA
OHT46115Medicare UPIN
OH000000127556OtherANTHEM