1265446116 NPI number — ROMANOFF OPTICAL, LTD.

Table of content: JOSEPH LEONARDO JORDAN LMT (NPI 1912469008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265446116 NPI number — ROMANOFF OPTICAL, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROMANOFF OPTICAL, LTD.
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:
Provider Other Organization Name Type Code:
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:
1265446116
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 HARROUN RD
Provider Second Line Business Mailing Address:
SUITE 112
Provider Business Mailing Address City Name:
SYLVANIA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43560-2182
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-882-5146
Provider Business Mailing Address Fax Number:
419-882-5209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5300 HARROUN RD
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
SYLVANIA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43560-2182
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-882-5146
Provider Business Practice Location Address Fax Number:
419-882-5209
Provider Enumeration Date:
07/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROMANOFF
Authorized Official First Name:
HEDVA
Authorized Official Middle Name:
T
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
419-882-5146

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  48173821 , 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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