Provider Demographics
NPI:1730101742
Name:LIGHT, WILLIAM O (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:O
Last Name:LIGHT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1005 BELLEFONTAINE AVE
Mailing Address - Street 2:STE 225
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2896
Mailing Address - Country:US
Mailing Address - Phone:419-228-8191
Mailing Address - Fax:419-229-3490
Practice Address - Street 1:1005 BELLEFONTAINE AVE
Practice Address - Street 2:STE 225
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2896
Practice Address - Country:US
Practice Address - Phone:419-228-8191
Practice Address - Fax:419-229-3490
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
OH35034390L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0194463Medicaid
A74721Medicare UPIN
OH0194463Medicaid