Provider Demographics
NPI:1659070563
Name:UCADZE, MARINA
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:UCADZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7235 MARKET PLACE DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-8758
Mailing Address - Country:US
Mailing Address - Phone:330-562-6350
Mailing Address - Fax:330-562-9528
Practice Address - Street 1:7235 MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-8758
Practice Address - Country:US
Practice Address - Phone:330-562-6350
Practice Address - Fax:330-562-9528
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSC.9873156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician