Provider Demographics
NPI:1265446116
Name:ROMANOFF OPTICAL, LTD.
Entity Type:Organization
Organization Name:ROMANOFF OPTICAL, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEDVA
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROMANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-882-5146
Mailing Address - Street 1:5300 HARROUN RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2182
Mailing Address - Country:US
Mailing Address - Phone:419-882-5146
Mailing Address - Fax:419-882-5209
Practice Address - Street 1:5300 HARROUN RD
Practice Address - Street 2:SUITE 112
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2182
Practice Address - Country:US
Practice Address - Phone:419-882-5146
Practice Address - Fax:419-882-5209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH48173821332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4642120001Medicare NSC