1730694142 NPI number — FAIRVIEW EYE CENTER, INC

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 1730694142 NPI number — FAIRVIEW EYE CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRVIEW EYE CENTER, 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 CENTER OF MIDDLEBURG HEIGHTS
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:
1730694142
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21375 LORAIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRVIEW PARK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44126-2122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-333-3060
Provider Business Mailing Address Fax Number:
440-333-0273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7003 PEARL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44130-4941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-888-2333
Provider Business Practice Location Address Fax Number:
440-888-2335
Provider Enumeration Date:
12/07/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WEILLS
Authorized Official First Name:
JANENE
Authorized Official Middle Name:
Authorized Official Title or Position:
REFERRAL COORDINATOR
Authorized Official Telephone Number:
440-333-3060

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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