Basic Information
| Provider Information | |||||||||
| NPI: | 1184175333 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WING EYECARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2920 GLENDALE MILFORD RD | ||||||||
| Address2: | SUITE 220 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452413131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5139229000 | ||||||||
| FaxNumber: | 5139224050 | ||||||||
| Practice Location | |||||||||
| Address1: | 5305 GLENWAY AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452383706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132519464 | ||||||||
| FaxNumber: | 5133470078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2016 | ||||||||
| LastUpdateDate: | 10/21/2016 | ||||||||
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| AuthorizedOfficialLastName: | NAGY | ||||||||
| AuthorizedOfficialFirstName: | THOMAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5135573666 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4131 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.