Provider Demographics
NPI:1538867163
Name:INGALLS, HOWARD D (OP10148S OHIO)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:D
Last Name:INGALLS
Suffix:
Gender:M
Credentials:OP10148S OHIO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 HOKE RD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45315-9725
Mailing Address - Country:US
Mailing Address - Phone:937-564-5905
Mailing Address - Fax:
Practice Address - Street 1:7725 HOKE RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45315-9725
Practice Address - Country:US
Practice Address - Phone:937-564-5905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.10148.S156FX1800X
OHOP.10148S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH103697076Medicaid