Provider Demographics
NPI:1326396060
Name:MARYMOUNT OPTICAL
Entity Type:Organization
Organization Name:MARYMOUNT OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILDIKO
Authorized Official - Middle Name:
Authorized Official - Last Name:KONDRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-581-0470
Mailing Address - Street 1:12000 MCCRACKEN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-2933
Mailing Address - Country:US
Mailing Address - Phone:216-581-0470
Mailing Address - Fax:216-581-0474
Practice Address - Street 1:12000 MCCRACKEN RD STE 101
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2933
Practice Address - Country:US
Practice Address - Phone:216-581-0470
Practice Address - Fax:216-581-0474
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEVELAND OPHTHALMOLOGY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty