1265498554 NPI number — DR. LARRY E TOPE OD

Table of content: DR. LARRY E TOPE OD (NPI 1265498554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265498554 NPI number — DR. LARRY E TOPE OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOPE
Provider First Name:
LARRY
Provider Middle Name:
E
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265498554
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 W WAYNE ST
Provider Second Line Business Mailing Address:
PO BOX 252
Provider Business Mailing Address City Name:
PAULDING
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45879
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-399-2255
Provider Business Mailing Address Fax Number:
419-399-9857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 W WAYNE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAULDING
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45879-1538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-399-2255
Provider Business Practice Location Address Fax Number:
419-399-9857
Provider Enumeration Date:
04/25/2006

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:  3575T683 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 050560001 . This is a "ADMINISTAR SUPPLIER" identifier . This identifiers is of the category "OTHER".