Provider Demographics
NPI:1073664447
Name:VERLICH, GEORGE PHILLIP (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:PHILLIP
Last Name:VERLICH
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 1:7129 JOSEPHINE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-5003
Mailing Address - Country:US
Mailing Address - Phone:440-235-4026
Mailing Address - Fax:
Practice Address - Street 1:5000 GREAT NORTHERN MALL
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-3303
Practice Address - Country:US
Practice Address - Phone:440-777-8168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3158152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist