Provider Demographics
NPI:1407929755
Name:MEDICAL EYE ASSOC INC
Entity Type:Organization
Organization Name:MEDICAL EYE ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMROVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-888-2333
Mailing Address - Street 1:7003 PEARL RD
Mailing Address - Street 2:STE 200
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-4941
Mailing Address - Country:US
Mailing Address - Phone:440-888-2333
Mailing Address - Fax:440-888-2335
Practice Address - Street 1:7003 PEARL RD
Practice Address - Street 2:STE 200
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-4941
Practice Address - Country:US
Practice Address - Phone:440-888-2333
Practice Address - Fax:440-888-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2005145Medicaid
OH9922901Medicare PIN
OH9922903Medicare PIN