Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3579T706 | OH |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 3579T706 | OH |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 3579T706 | OH |
N | 152WP0200X | Pediatric Optomitrist | 3579T706 | OH |
N | 152WV0400X | Optomitrist - Vision Therapist | 3579T706 | OH |
NPI | 1073659512 |
---|---|
Provider Name | Michael J Woloschak |
First Address | Austintown, OH 44515-5344 |
Second Address | Austintown, OH 44515-5344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 21/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000142252 | ANTHEM (01) | OH |
0560576 | (05) | OH |
2200637 | UHC MEDICARE COMPLETE (01) | OH |
2200637 | UNITED HEALTH CARE (01) | OH |
341923934 | UNISON (01) | OH |
341923934027 | CARESOURCE (01) | OH |
410047096 | RAILROAD MEDICARE (01) | OH |
T47958 | (02) | OH |