Provider Demographics
NPI:1164492591
Name:FAIRVIEW EYE CENTER
Entity Type:Organization
Organization Name:FAIRVIEW EYE CENTER
Other - Org Name:LAKEWOOD EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARAVELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-228-1800
Mailing Address - Street 1:21375 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2122
Mailing Address - Country:US
Mailing Address - Phone:440-333-7346
Mailing Address - Fax:440-333-0273
Practice Address - Street 1:16400 HILLIARD RD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5610
Practice Address - Country:US
Practice Address - Phone:216-228-1800
Practice Address - Fax:216-228-1162
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAIRVIEW EYE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-26
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH556859207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0826931Medicaid
OH0769770001OtherADMINISTAR DME
OH=========003OtherMEDICAL MUTUAL
OH0769770001OtherADMINISTAR DME
OH=========00OtherWORKERS COMP
OH0826931Medicaid
OH9925093Medicare PIN
OHCJ0366Medicare ID - Type UnspecifiedRAILROAD MEDICARE