1427051697 NPI number — HILLCREST-MAYFIELD EYE ASSOCIATES, 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 1427051697 NPI number — HILLCREST-MAYFIELD EYE ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HILLCREST-MAYFIELD EYE ASSOCIATES, 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:
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:
1427051697
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6770 MAYFIELD RD
Provider Second Line Business Mailing Address:
STE 338
Provider Business Mailing Address City Name:
MAYFIELD HTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44124-2299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-442-4330
Provider Business Mailing Address Fax Number:
440-442-4695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6770 MAYFIELD RD
Provider Second Line Business Practice Location Address:
STE 338
Provider Business Practice Location Address City Name:
MAYFIELD HTS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44124-2299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-442-4330
Provider Business Practice Location Address Fax Number:
440-442-4695
Provider Enumeration Date:
05/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SHIN
Authorized Official First Name:
Y.
Authorized Official Middle Name:
VICTOR
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
440-442-4330

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  580800 , 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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