Provider Demographics
NPI:1417247826
Name:CLEVELAND EYE CARE & SURGERY, INC.
Entity Type:Organization
Organization Name:CLEVELAND EYE CARE & SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-297-3230
Mailing Address - Street 1:24755 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 345
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5682
Mailing Address - Country:US
Mailing Address - Phone:216-297-3230
Mailing Address - Fax:216-342-5290
Practice Address - Street 1:12000 MCCRACKEN RD
Practice Address - Street 2:SUITE 215
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2964
Practice Address - Country:US
Practice Address - Phone:216-581-6111
Practice Address - Fax:216-291-4849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000725689OtherANTHEM BLUE CROSS AND BLUE SHIELD
OH=========-01OtherOHIO BUREAU OF WORKERS COMPENSATION
OH=========-01OtherOHIO BUREAU OF WORKERS COMPENSATION