Provider Demographics
NPI:1326236829
Name:CASE OPTICAL OF EUCLID
Entity Type:Organization
Organization Name:CASE OPTICAL OF EUCLID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:BASILE
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:216-261-3600
Mailing Address - Street 1:26300 EUCLID AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-3708
Mailing Address - Country:US
Mailing Address - Phone:216-261-3600
Mailing Address - Fax:216-261-3601
Practice Address - Street 1:26300 EUCLID AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3708
Practice Address - Country:US
Practice Address - Phone:216-261-3600
Practice Address - Fax:216-261-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1054-S332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5092650001Medicare NSC