Provider Demographics
NPI:1578915385
Name:SOPHIA K. FOTINOS O.D., LLC
Entity Type:Organization
Organization Name:SOPHIA K. FOTINOS O.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOTINOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:216-227-2020
Mailing Address - Street 1:30233 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5130
Mailing Address - Country:US
Mailing Address - Phone:440-829-4295
Mailing Address - Fax:
Practice Address - Street 1:14553 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4325
Practice Address - Country:US
Practice Address - Phone:216-227-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6197152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty