Provider Demographics
NPI:1245406859
Name:DR. PHILLIP A. KADES
Entity Type:Organization
Organization Name:DR. PHILLIP A. KADES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:KADES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-626-2020
Mailing Address - Street 1:9088 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-5699
Mailing Address - Country:US
Mailing Address - Phone:330-626-2020
Mailing Address - Fax:
Practice Address - Street 1:9088 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-5699
Practice Address - Country:US
Practice Address - Phone:330-626-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-03
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2969152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9237781Medicare PIN