Provider Demographics
NPI:1033280748
Name:BELMONT EYE CLINIC, INC.
Entity Type:Organization
Organization Name:BELMONT EYE CLINIC, INC.
Other - Org Name:BELMONT EYE CLINIC - CANFIELD OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:LISOTTO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:330-759-7672
Mailing Address - Street 1:4137 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8087
Mailing Address - Country:US
Mailing Address - Phone:330-533-1097
Mailing Address - Fax:330-533-6940
Practice Address - Street 1:4137 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8087
Practice Address - Country:US
Practice Address - Phone:330-533-1097
Practice Address - Fax:330-533-6940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBE9179762Medicare ID - Type Unspecified
OH0397080003Medicare NSC