Provider Demographics
NPI:1083804140
Name:EYE OPTICAL, INC
Entity Type:Organization
Organization Name:EYE OPTICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-351-7400
Mailing Address - Street 1:5249 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1626
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:216-661-5454
Practice Address - Street 1:5249 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1626
Practice Address - Country:US
Practice Address - Phone:216-351-7400
Practice Address - Fax:216-661-5454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4353SC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0494160001Medicare NSC