Provider Demographics
NPI:1598934069
Name:CLEVELAND VISION CENTER INC
Entity Type:Organization
Organization Name:CLEVELAND VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-351-6270
Mailing Address - Street 1:6204 BROOKPARK ROAD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44129-1218
Mailing Address - Country:US
Mailing Address - Phone:216-351-6270
Mailing Address - Fax:216-351-6130
Practice Address - Street 1:6204 BROOKPARK ROAD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44129-1218
Practice Address - Country:US
Practice Address - Phone:216-351-6270
Practice Address - Fax:216-351-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2614152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0171310001Medicare NSC
OH9925861Medicare PIN
OHT46164Medicare UPIN