Provider Demographics
NPI:1669643441
Name:CASE OPTICAL CO
Entity Type:Organization
Organization Name:CASE OPTICAL CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIS.OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ONESKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-751-9800
Mailing Address - Street 1:3970 WARRENSVILLE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3970 WARRENSVILLE CENTER RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44122-6770
Practice Address - Country:US
Practice Address - Phone:216-751-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0662460001Medicare NSC