Provider Demographics
NPI:1659467900
Name:WESTERN RESERVE VISION CARE, INC.
Entity Type:Organization
Organization Name:WESTERN RESERVE VISION CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY JO
Authorized Official - Middle Name:
Authorized Official - Last Name:STIEGEMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-650-9599
Mailing Address - Street 1:3690 ORANGE PLACE #150
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-839-0200
Mailing Address - Fax:216-839-0808
Practice Address - Street 1:3690 ORANGE PL
Practice Address - Street 2:SUITE #150
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4464
Practice Address - Country:US
Practice Address - Phone:216-839-0200
Practice Address - Fax:216-839-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
OH152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9310391Medicare ID - Type Unspecified