1265537179 NPI number — THE CLEVELAND CLINIC FOUNDATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265537179 NPI number — THE CLEVELAND CLINIC FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CLEVELAND CLINIC FOUNDATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CLEVELAND CLINIC OPHTHALMOLOGY AT OBERLIN
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265537179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6000 W CREEK RD
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44131-2139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-223-2273
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 W LORAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OBERLIN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44074-1027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-988-4040
Provider Business Practice Location Address Fax Number:
440-988-4041
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LONGVILLE
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CHIEF ACCT OFFICER AND CONTROLLER
Authorized Official Telephone Number:
216-636-7416

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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