Wizard of Eyes, Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

5771 Issued in OH

Legal business name

WIZARD OF EYES, INC

Practice address

9878 Brewster LN
Box 108
Powell, OH 43065-7980

Phone

(614) 619-7973

Fax

(614) 789-6399

NPI assigned

Jun 11, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark Desmon Roudebush, OD

Title

President

Phone

(614) 619-7973

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407283200000",
    "number": "1386057941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2725 S HAMILTON RD",
            "address_2": "G-5",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432324904",
            "telephone_number": "614-863-0195",
            "fax_number": "614-863-2701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9878 BREWSTER LN",
            "address_2": "BOX 108",
            "city": "POWELL",
            "state": "OH",
            "postal_code": "430657980",
            "telephone_number": "614-619-7973",
            "fax_number": "614-789-6399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WIZARD OF EYES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-11",
        "last_updated": "2014-08-06",
        "status": "A",
        "authorized_official_last_name": "ROUDEBUSH",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "DESMON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "614-619-7973",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OH",
            "license": "5771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0102912",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Marie Williamson, NP
• Meaghan Wilson, MA, CCC-SLP
• Tammy Oweida Wilson, LMT
• Melissa June Winkie, MD
• Beth Wise
• Janet K Wolery, DMD
• Kassi Wolfe, CT
• Women'S Health Partners, LLC
• Joseph Wilbur Woods, M.D.
• William Glendon Woodward

• Optometrist in Powell, OH
• Providers in Powell, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.