Provider Demographics
NPI:1558454728
Name:MCGANN, WILLIAM WEBER (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WEBER
Last Name:MCGANN
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 1:733 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-3407
Mailing Address - Country:US
Mailing Address - Phone:330-678-8682
Mailing Address - Fax:
Practice Address - Street 1:6751 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3903
Practice Address - Country:US
Practice Address - Phone:330-296-6293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4524/T1220152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU32127Medicare ID - Type Unspecified