Provider Demographics
NPI:1447420187
Name:PLEASANT VALLEY EYECARE
Entity Type:Organization
Organization Name:PLEASANT VALLEY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAPANZANO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:216-642-5500
Mailing Address - Street 1:7630 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-6745
Mailing Address - Country:US
Mailing Address - Phone:216-642-5500
Mailing Address - Fax:
Practice Address - Street 1:7630 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-6745
Practice Address - Country:US
Practice Address - Phone:216-642-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3529152WC0802X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0147000001Medicare NSC