Provider Demographics
NPI:1871647230
Name:RATH, TED A (OD)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:A
Last Name:RATH
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 1:1174 ALLIANCE RD NW
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-8736
Mailing Address - Country:US
Mailing Address - Phone:330-868-0076
Mailing Address - Fax:330-868-4096
Practice Address - Street 1:1174 ALLIANCE ROAD
Practice Address - Street 2:
Practice Address - City:MINERVA
Practice Address - State:OH
Practice Address - Zip Code:44657
Practice Address - Country:US
Practice Address - Phone:330-868-0076
Practice Address - Fax:330-868-4096
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4308T212152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1114550001Medicare NSC
OH0719234Medicare PIN
U32722Medicare UPIN