IndividualActive
Andre Willis, LDO/NCLE
NPI 1003511098 · Optician · Kent, OH
Provider details
- NPI number
- 1003511098
- Entity type
- Individual
- Primary specialty
- OpticianEye and Vision Services Providers
- Credential
- LDO/NCLE
- Sex
- Male
- Sole proprietor
- Yes
- License
- OP.006709-SC (OH)
Specialties & taxonomies
Eye and Vision Services Providers
Practice location
250 Tallmadge Rd
Kent, OH 44240-7204
Phone: (330) 673-3516
Fax: (330) 673-3538
Approximate (ZIP-level) locationGet directions
Mailing address
250 Tallmadge Rd
Kent, OH 44240-7204
Registry dates
- Enumerated
- 2023-03-31
- Last updated
- 2023-03-31
- Certified
- 2023-03-31
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.