Provider Demographics
NPI:1164401113
Name:ALTON, PAUL JOSEPH (OD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JOSEPH
Last Name:ALTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4650 OBERLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3115
Mailing Address - Country:US
Mailing Address - Phone:440-282-9800
Mailing Address - Fax:440-282-1697
Practice Address - Street 1:4650 OBERLIN AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3115
Practice Address - Country:US
Practice Address - Phone:440-282-9800
Practice Address - Fax:440-282-1697
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3997152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0821141Medicaid
OH410035801Medicare PIN
U25428Medicare UPIN
OH0821141Medicaid