Provider Demographics
NPI:1386813723
Name:KOVESDY FAMILY EYECARE, INC.
Entity Type:Organization
Organization Name:KOVESDY FAMILY EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KOVESDY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-455-1160
Mailing Address - Street 1:25125 DETROIT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2547
Mailing Address - Country:US
Mailing Address - Phone:440-455-1160
Mailing Address - Fax:440-455-1194
Practice Address - Street 1:25125 DETROIT RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2547
Practice Address - Country:US
Practice Address - Phone:440-455-1160
Practice Address - Fax:440-455-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4293332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0365050001Medicare NSC