Provider Demographics
NPI:1326271206
Name:EYEWEAR INTERNATIONAL/TV OPTICIANS
Entity Type:Organization
Organization Name:EYEWEAR INTERNATIONAL/TV OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-896-0316
Mailing Address - Street 1:23611 CHAGRIN BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5540
Mailing Address - Country:US
Mailing Address - Phone:216-896-0316
Mailing Address - Fax:216-896-9997
Practice Address - Street 1:23611 CHAGRIN BLVD STE 120
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5540
Practice Address - Country:US
Practice Address - Phone:216-896-0316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5656332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0188872Medicaid
OH6220550001Medicare PIN