Provider Demographics
NPI:1245234020
Name:VASKO, JOANN L (OD)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:L
Last Name:VASKO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16450 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-6015
Mailing Address - Country:US
Mailing Address - Phone:440-572-2866
Mailing Address - Fax:
Practice Address - Street 1:6801 PEARL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3616
Practice Address - Country:US
Practice Address - Phone:440-845-3006
Practice Address - Fax:440-884-5951
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4087/689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHVA0683589Medicare ID - Type Unspecified
OHU54013Medicare UPIN