Provider Demographics
NPI:1164415147
Name:WIND, BRIAN E (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:E
Last Name:WIND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3545 LINCOLN WAY E
Mailing Address - Street 2:SUITE A
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-3707
Mailing Address - Country:US
Mailing Address - Phone:330-837-5191
Mailing Address - Fax:330-837-0755
Practice Address - Street 1:3545 LINCOLN WAY E
Practice Address - Street 2:SUITE A
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8624
Practice Address - Country:US
Practice Address - Phone:330-837-5191
Practice Address - Fax:330-837-0755
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2012-06-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34. 005043207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0929875Medicaid
OH0929875Medicaid
OH0439750002Medicare NSC
OH0439750001Medicare NSC
F31281Medicare UPIN