Provider Demographics
NPI:1609841733
Name:GEORGE E ATANASOFF OD INC
Entity Type:Organization
Organization Name:GEORGE E ATANASOFF OD INC
Other - Org Name:EYE & VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:ATANASOFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-666-6789
Mailing Address - Street 1:11925 PEARL RD
Mailing Address - Street 2:STE 104
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136
Mailing Address - Country:US
Mailing Address - Phone:440-238-7865
Mailing Address - Fax:440-238-3888
Practice Address - Street 1:11925 PEARL RD
Practice Address - Street 2:STE 104
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136
Practice Address - Country:US
Practice Address - Phone:440-238-7865
Practice Address - Fax:440-238-3888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4264T023152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0459150Medicaid
0820960001OtherDMERC
U29863Medicare UPIN
OHAT088241Medicare ID - Type Unspecified