1558651968 NPI number — CLEVELAND EYE CARE & SURGERY, INC.

Table of content: (NPI 1558651968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558651968 NPI number — CLEVELAND EYE CARE & SURGERY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEVELAND EYE CARE & SURGERY, 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:
1558651968
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24755 CHAGRIN BLVD
Provider Second Line Business Mailing Address:
SUITE 345
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-5682
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-297-3230
Provider Business Mailing Address Fax Number:
216-342-5290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36100 EUCLID AVE
Provider Second Line Business Practice Location Address:
SUITE 450
Provider Business Practice Location Address City Name:
WILLOUGHBY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44094-4456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-297-3230
Provider Business Practice Location Address Fax Number:
216-291-4849
Provider Enumeration Date:
04/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
216-297-3230

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)

  • Identifier: 000000725689 . This is a "ANTHEM BLUE CROSS AND BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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