Provider Demographics
NPI:1801645890
Name:PACLEB, GREGORY SHELDON
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:SHELDON
Last Name:PACLEB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W DOROTHY LN
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1838
Mailing Address - Country:US
Mailing Address - Phone:937-643-2707
Mailing Address - Fax:
Practice Address - Street 1:1701 W DOROTHY LN
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1838
Practice Address - Country:US
Practice Address - Phone:937-643-2707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.017727-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician