Provider Demographics
NPI:1275512709
Name:FAIRVIEW EYE CENTER, INC
Entity Type:Organization
Organization Name:FAIRVIEW EYE CENTER, INC
Other - Org Name:THE EYE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOIZOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-333-7346
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 1:21375 LORAIN RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-2122
Practice Address - Country:US
Practice Address - Phone:440-333-7346
Practice Address - Fax:440-333-0273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH556859152W00000X, 207W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1382523OtherUMWA
OHCJ0366OtherRAILROAD MEDICARE ID LEGACY
OH0769770001OtherADMINISTAR DME
OH0826931Medicaid
OH0826931Medicaid
OH=========003OtherMEDICAL MUTUAL
OH9925093Medicare PIN
OH0769770001Medicare NSC
OH0826931Medicaid