Provider Demographics
NPI:1447431119
Name:MICHAEL J WOLOSCHAK OD INC
Entity Type:Organization
Organization Name:MICHAEL J WOLOSCHAK OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOLOSCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-799-3937
Mailing Address - Street 1:2670 S RACCOON RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44515-5380
Mailing Address - Country:US
Mailing Address - Phone:330-799-3937
Mailing Address - Fax:330-799-1557
Practice Address - Street 1:2670 S RACCOON RD
Practice Address - Street 2:SUITE #1
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-5380
Practice Address - Country:US
Practice Address - Phone:330-799-3937
Practice Address - Fax:330-799-1557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000142252OtherANTHEM
53992OtherUNISON
410047096OtherRAILROAD MEDICARE
OH0560576Medicaid
118090OtherEYEMED
2200637OtherUNITED HEALTHCARE
289440488009OtherMEDICAL MUTUAL
2200637OtherUNITED HEALTHCARE
2200637OtherUNITED HEALTHCARE
289440488009OtherMEDICAL MUTUAL
=========027OtherCARESOURCE