Provider Demographics
NPI:1427015932
Name:NORTH RIDGEVILLE EYE CARE INC
Entity Type:Organization
Organization Name:NORTH RIDGEVILLE EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-327-2020
Mailing Address - Street 1:7079 AVON BELDEN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-3774
Mailing Address - Country:US
Mailing Address - Phone:440-327-2020
Mailing Address - Fax:440-327-5174
Practice Address - Street 1:7079 AVON BELDEN RD
Practice Address - Street 2:
Practice Address - City:NORTH RIDGEVILLE
Practice Address - State:OH
Practice Address - Zip Code:44039-3774
Practice Address - Country:US
Practice Address - Phone:440-327-2020
Practice Address - Fax:440-327-5174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-27
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3430152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2840439Medicaid
OH=========OtherCARESOURCE
OH=========00OtherBUREAU OF WORKERS COMP
OH=========001OtherMEDICAL MUTUAL
OH=========OtherVISION CARE PLAN
OH2840439Medicaid
OH2840439Medicaid
OH4640970001Medicare NSC
OH9329141Medicare PIN