Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3806/T1491 | OH |
NPI | 1013022011 |
---|---|
Provider Name | Dr. Michael Joseph Kacere JR. |
First Address | Wooster, OH 44691-7220 |
Second Address | Wooster, OH 44691-7220 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |