Provider Demographics
NPI:1427230028
Name:BELLA VISTA TOTAL EYECARE
Entity Type:Organization
Organization Name:BELLA VISTA TOTAL EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANAL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ASSAAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-433-0222
Mailing Address - Street 1:7168 FULTON DR NW
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-1523
Mailing Address - Country:US
Mailing Address - Phone:330-433-0222
Mailing Address - Fax:
Practice Address - Street 1:7168 FULTON DR NW
Practice Address - Street 2:SUITE 111
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-1523
Practice Address - Country:US
Practice Address - Phone:330-433-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier