Provider Demographics
NPI:1841307675
Name:CANTON OPTOMETRY CORPORATION
Entity type:Organization
Organization Name:CANTON OPTOMETRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENDELAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-494-1710
Mailing Address - Street 1:4865 FRANK AVE NW
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-7425
Mailing Address - Country:US
Mailing Address - Phone:330-494-1710
Mailing Address - Fax:330-494-5815
Practice Address - Street 1:4865 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7425
Practice Address - Country:US
Practice Address - Phone:330-494-1710
Practice Address - Fax:330-494-5815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9269872Medicare PIN
OH9269873Medicare PIN
OH9269871Medicare PIN