Provider Demographics
NPI:1063683647
Name:DR. JOHN J DEVITO INC.
Entity Type:Organization
Organization Name:DR. JOHN J DEVITO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DEVITO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-493-9803
Mailing Address - Street 1:3703 CLEVELAND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-2315
Mailing Address - Country:US
Mailing Address - Phone:330-493-9803
Mailing Address - Fax:330-493-9804
Practice Address - Street 1:3703 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-2315
Practice Address - Country:US
Practice Address - Phone:330-493-9803
Practice Address - Fax:330-493-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-21
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4094/T86152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0765319Medicaid
OH0157111Medicare PIN
OHT46055Medicare UPIN