Provider Demographics
NPI:1457348518
Name:MIEDEL, ANSON T (MD)
Entity Type:Individual
Prefix:
First Name:ANSON
Middle Name:T
Last Name:MIEDEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089887207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2757584Medicaid
I42597Medicare UPIN
OH4211573Medicare PIN
OH2757584Medicaid
OH4211572Medicare PIN
P00413684Medicare PIN