Provider Demographics
NPI:1467621854
Name:ERIC J PAUL
Entity Type:Organization
Organization Name:ERIC J PAUL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:JAN
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-297-1211
Mailing Address - Street 1:6693 N CHESTNUT ST STE 12B
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3900
Mailing Address - Country:US
Mailing Address - Phone:330-297-1211
Mailing Address - Fax:330-297-6550
Practice Address - Street 1:6693 N CHESTNUT ST STE 12B
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-3900
Practice Address - Country:US
Practice Address - Phone:330-297-1211
Practice Address - Fax:330-297-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002415332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0877940001Medicare NSC