Provider Demographics
NPI:1578564449
Name:OXLEY, WALTER H (OD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:H
Last Name:OXLEY
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 1:126 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-3022
Mailing Address - Country:US
Mailing Address - Phone:419-334-9779
Mailing Address - Fax:419-334-4545
Practice Address - Street 1:126 S FRONT ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-3022
Practice Address - Country:US
Practice Address - Phone:419-334-9779
Practice Address - Fax:419-334-4545
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3041/T585152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0149760001Medicare NSC
OH9327151Medicare PIN
OHT47034Medicare UPIN