Provider Demographics
NPI:1831963800
Name:RADABAUGH, PHILLIP S
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:S
Last Name:RADABAUGH
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 1:1161 TRENTON AVE
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1919
Mailing Address - Country:US
Mailing Address - Phone:419-425-5611
Mailing Address - Fax:419-425-5715
Practice Address - Street 1:1161 TRENTON AVE
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1919
Practice Address - Country:US
Practice Address - Phone:419-425-5611
Practice Address - Fax:419-425-5715
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician