Provider Demographics
NPI:1023280609
Name:JOSEPH WM BABCOCK
Entity type:Organization
Organization Name:JOSEPH WM BABCOCK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:O.D.
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-353-2191
Mailing Address - Street 1:721 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4018
Mailing Address - Country:US
Mailing Address - Phone:740-353-2191
Mailing Address - Fax:
Practice Address - Street 1:721 7TH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4018
Practice Address - Country:US
Practice Address - Phone:740-353-2191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332H00000X
OH3520152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0466160001Medicare NSC