Provider Demographics
NPI:1225096696
Name:MISKE, CAROL ANN (OD)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:MISKE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CAROL
Other - Middle Name:ANN
Other - Last Name:NOVAK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7079 AVON BELDEN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-3774
Mailing Address - Country:US
Mailing Address - Phone:440-327-2020
Mailing Address - Fax:440-327-5174
Practice Address - Street 1:7079 AVON BELDEN RD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-3774
Practice Address - Country:US
Practice Address - Phone:440-327-2020
Practice Address - Fax:440-327-5174
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3430152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0400926Medicaid
OH410049138OtherRAILROAD MEDICARE
OH4640970001OtherADMINISTAR FEDERAL IMERC
OH410049138OtherRAILROAD MEDICARE
OH0400926Medicaid