Provider Demographics
NPI:1679651640
Name:JOSEPH D SCHWALLIE OD INC
Entity Type:Organization
Organization Name:JOSEPH D SCHWALLIE OD INC
Other - Org Name:ORACLE VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHWALLIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-865-7125
Mailing Address - Street 1:7121 ORCHARD CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-7975
Mailing Address - Country:US
Mailing Address - Phone:419-865-7125
Mailing Address - Fax:419-865-8337
Practice Address - Street 1:7121 ORCHARD CENTRE DR
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-7975
Practice Address - Country:US
Practice Address - Phone:419-865-7125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4232152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0851124OtherMEDICARE PROVIDER#
OH1316800001Medicare NSC
OH9299792Medicare PIN