Provider Demographics
NPI:1669640124
Name:WADSWORTH EYE CLINIC, INC
Entity Type:Organization
Organization Name:WADSWORTH EYE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BIEDENBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-247-2480
Mailing Address - Street 1:1197 HIGH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8282
Mailing Address - Country:US
Mailing Address - Phone:330-247-2480
Mailing Address - Fax:330-336-0099
Practice Address - Street 1:1197 HIGH ST STE 106
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8282
Practice Address - Country:US
Practice Address - Phone:330-247-2480
Practice Address - Fax:330-336-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5652152W00000X
OH35085999207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHEX9374971Medicare PIN
6131730001Medicare NSC