Provider Demographics
NPI:1114114634
Name:NORTH COAST OPHTHALMOLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:NORTH COAST OPHTHALMOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:CONFORTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-331-6855
Mailing Address - Street 1:21245 LORAIN RD
Mailing Address - Street 2:LL100
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2146
Mailing Address - Country:US
Mailing Address - Phone:440-331-6855
Mailing Address - Fax:440-331-9105
Practice Address - Street 1:21245 LORAIN RD
Practice Address - Street 2:LL100
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2146
Practice Address - Country:US
Practice Address - Phone:440-331-6855
Practice Address - Fax:440-331-9105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039945C207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9273741Medicare PIN