1073519849 NPI number — DR. PATRICK HENRY OD

Table of content: DR. PATRICK HENRY OD (NPI 1073519849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073519849 NPI number — DR. PATRICK HENRY OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENRY
Provider First Name:
PATRICK
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WCISLAK
Provider Other First Name:
PATRICK
Provider Other Middle Name:
HENRY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073519849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9640 OLDE US 20
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSSFORD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43460-1712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-874-4045
Provider Business Mailing Address Fax Number:
419-874-4061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9640 OLDE US 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSSFORD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43460-1712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-874-4045
Provider Business Practice Location Address Fax Number:
419-874-4061
Provider Enumeration Date:
06/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OH 5163 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: OH 5163 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WL0500X , with the licence number: OH 5163 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X , with the licence number: OH 5163 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WS0006X , with the licence number: OH 5163 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WV0400X , with the licence number: OH 5163 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WX0102X , with the licence number: OH 5163 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00002301855 03 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 020576130 . This is a "VISION SERVICE PLAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 04343 . This is a "PARAMOUNT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 622248 . This is a "STERLING LIFE INS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 21619 . This is a "SPECTERA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2196672 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 726015 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 0007384378 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 277680 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 44381 . This is a "DAVIS VISION" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: OH5163 . This is a "EYEMED" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 145799 . This is a "COLE MANAGED VISION" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 360355 . This is a "NATIONAL VISION ADMINISTR" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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