Provider Demographics
NPI:1851347116
Name:EVERT, WAYNE ROBERT (OD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:ROBERT
Last Name:EVERT
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 1:2355 MANCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44314-3639
Mailing Address - Country:US
Mailing Address - Phone:330-753-2266
Mailing Address - Fax:
Practice Address - Street 1:2355 MANCHESTER RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-3639
Practice Address - Country:US
Practice Address - Phone:330-753-2266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2893 T426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0178463Medicaid
OHT46801Medicare UPIN
OHEVO 424901Medicare ID - Type Unspecified