Individual
DR. RICHARD E WYSZYNSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4676 DOUGLAS CIR NW, CANTON, OH 44718-3619
(330) 494-1116
(330) 494-0276
Mailing address
4676 DOUGLAS CIR NW, CANTON, OH 44718-3619
(330) 494-1116
(330) 494-0276
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
35-054663-W
OH
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
35.054663
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000126323
ANTHEM
OH
01
—
0011833800001
MEDICAID
PA
01
—
0800331
UNITED HEALTHCARE
OH
05
—
0808602
—
OH
01
—
180011157
RAILROAD MEDICARE
OH
01
—
4125776
AETNA
OH
01
—
574789
KEYSTONE
OH
01
—
80523
QUALCHOICE
OH
01
—
M54663
SUMMACARE
OH
Enumeration date
08/15/2005
Last updated
06/02/2021
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