Individual
WILLIAM KEGERIZE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
603 MAIN ST, GENOA, OH 43430-1635
(419) 855-3640
(419) 855-4743
Mailing address
1606 DIER RD, CURTICE, OH 43412-9702
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5558
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3037403
—
OH
01
—
5558
STATE LICENSE NUMBER
OH
01
—
P01300310
RAILROAD MEDICARE
OH
Enumeration date
08/02/2005
Last updated
01/15/2019
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