Provider Demographics
NPI:1023091774
Name:VOYTILLA, EMILY CLAIRE (OD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:CLAIRE
Last Name:VOYTILLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:CLAIRE
Other - Last Name:ZANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:10730 MAIN ST
Mailing Address - City:MANTUA
Mailing Address - State:OH
Mailing Address - Zip Code:44255-0520
Mailing Address - Country:US
Mailing Address - Phone:330-274-0502
Mailing Address - Fax:
Practice Address - Street 1:10730 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANTUA
Practice Address - State:OH
Practice Address - Zip Code:44255
Practice Address - Country:US
Practice Address - Phone:330-274-0502
Practice Address - Fax:330-274-8184
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5352-T2261152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001408300OtherB/S
PA062185QE6Medicare ID - Type Unspecified
PA001408300OtherB/S