Provider Demographics
NPI:1780629337
Name:WOOSTER OPHTHALMOLOGISTS, INC.
Entity Type:Organization
Organization Name:WOOSTER OPHTHALMOLOGISTS, INC.
Other - Org Name:WOOSTER EYE CENTER; WOOSTER OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-345-7200
Mailing Address - Street 1:3519 FRIENDSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1241
Mailing Address - Country:US
Mailing Address - Phone:330-345-7200
Mailing Address - Fax:330-345-8029
Practice Address - Street 1:3519 FRIENDSVILLE RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1241
Practice Address - Country:US
Practice Address - Phone:330-345-7200
Practice Address - Fax:330-345-8029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0458115Medicaid
9915371Medicare PIN
9915372Medicare PIN
OH0458115Medicaid
9915373Medicare PIN
0305640001Medicare NSC