Provider Demographics
NPI:1912152158
Name:TODD D WERSTLER OD
Entity Type:Organization
Organization Name:TODD D WERSTLER OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:D
Authorized Official - Last Name:WERSTLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-494-0924
Mailing Address - Street 1:822 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-3157
Mailing Address - Country:US
Mailing Address - Phone:330-494-0924
Mailing Address - Fax:330-494-4633
Practice Address - Street 1:822 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-3157
Practice Address - Country:US
Practice Address - Phone:330-494-0924
Practice Address - Fax:330-494-4633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3506332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0444120Medicaid
OH0521721Medicare UPIN
OH0197250001Medicare NSC