Provider Demographics
NPI:1851823330
Name:WILLARD EYE CARE INC
Entity Type:Organization
Organization Name:WILLARD EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCACCINI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:567-207-5503
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890
Mailing Address - Country:US
Mailing Address - Phone:419-933-2741
Mailing Address - Fax:419-933-7281
Practice Address - Street 1:320 W WALTON ST
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890
Practice Address - Country:US
Practice Address - Phone:419-933-2741
Practice Address - Fax:419-933-7281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5906152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty