Provider Demographics
NPI:1477603546
Name:BRECKSVILLE OPTICIANS, INC
Entity Type:Organization
Organization Name:BRECKSVILLE OPTICIANS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:B
Authorized Official - Last Name:PARIS
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:440-526-5565
Mailing Address - Street 1:7640 CHIPPEWA RD
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-2310
Mailing Address - Country:US
Mailing Address - Phone:440-526-5565
Mailing Address - Fax:
Practice Address - Street 1:7640 CHIPPEWA RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-2310
Practice Address - Country:US
Practice Address - Phone:440-526-5565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4818SC332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH17173OtherKAISER
OHBR299568OtherCLARITY
OHOH5029OtherEYEMED
OH17173OtherKAISER