Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4481 | OH |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 4481 | OH |
N | 152WP0200X | Pediatric Optomitrist | 4481 | OH |
N | 152WX0102X | Occupational Vision | 4481 | OH |
NPI | 1043203078 |
---|---|
Provider Name | Dr. Peter V. Mogyordy |
First Address | Westlake, OH 44145-2370 |
Second Address | Westlake, OH 44145-2370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 14/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U45523 | (02) | OH |