1609841733 NPI number — GEORGE E ATANASOFF OD INC

Table of content: (NPI 1609841733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609841733 NPI number — GEORGE E ATANASOFF OD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGE E ATANASOFF OD INC
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:
EYE & VISION CENTER
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:
1609841733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11925 PEARL RD
Provider Second Line Business Mailing Address:
STE 104
Provider Business Mailing Address City Name:
STRONGSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-238-7865
Provider Business Mailing Address Fax Number:
440-238-3888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11925 PEARL RD
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
STRONGSVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-238-7865
Provider Business Practice Location Address Fax Number:
440-238-3888
Provider Enumeration Date:
02/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ATANASOFF
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
ELLIOTT
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-666-6789

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  4264T023 , 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)

  • Identifier: 0459150 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0820960001 . This is a "DMERC" identifier . This identifiers is of the category "OTHER".




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