Organization
EYES 20/20
Active
Organization
EYES 20/20
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RONALD WALLIE OD (OWNER)
(330) 872-1371
Entity
Organization
Contact information
Practice address
115 W BROAD ST, SUITE A, NEWTON FALLS, OH 44444-1572
(330) 872-1371
Mailing address
115 W BROAD ST, SUITE A, NEWTON FALLS, OH 44444-1572
(330) 872-1371
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3576
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000227072
ANTHEM
OH
05
—
0481072
—
OH
01
—
272443180010
MEDICAL MUTUAL
OH
01
—
42685
DAVIS
OH
01
—
OH3576
EYEMED
OH
Enumeration date
10/25/2007
Last updated
01/04/2011
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