Provider Demographics
NPI:1376858472
Name:WAPAK VISION CENTER INC
Entity Type:Organization
Organization Name:WAPAK VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:FLECK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-738-3800
Mailing Address - Street 1:5 W AUGLAIZE ST
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-1549
Mailing Address - Country:US
Mailing Address - Phone:419-738-3800
Mailing Address - Fax:419-738-3899
Practice Address - Street 1:5 W AUGLAIZE ST
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-1549
Practice Address - Country:US
Practice Address - Phone:419-738-3800
Practice Address - Fax:419-738-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6468700001Medicare NSC
OH9390391Medicare PIN