Provider Demographics
NPI:1306804471
Name:BABCOCK, JOSEPH WM (OD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WM
Last Name:BABCOCK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 7TH ST.
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-4031
Mailing Address - Country:US
Mailing Address - Phone:740-353-2191
Mailing Address - Fax:740-354-4882
Practice Address - Street 1:721 7TH ST.
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-4031
Practice Address - Country:US
Practice Address - Phone:740-353-2191
Practice Address - Fax:740-354-4882
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3520152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0474848Medicaid
OH410032045Medicare PIN
T48228Medicare UPIN
OH0474848Medicaid