Provider Demographics
NPI:1689132797
Name:THE CLEVELAND CLINIC FOUNDATION
Entity Type:Organization
Organization Name:THE CLEVELAND CLINIC FOUNDATION
Other - Org Name:CCF COLE EYE LAKEWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ACCT OFFICER AND CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LONGVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-636-7416
Mailing Address - Street 1:6801 BRECKSVILLE ROAD
Mailing Address - Street 2:SUITE 20 RK2-7
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-5058
Mailing Address - Country:US
Mailing Address - Phone:216-636-8926
Mailing Address - Fax:216-442-1272
Practice Address - Street 1:16215 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5618
Practice Address - Country:US
Practice Address - Phone:216-237-5888
Practice Address - Fax:216-521-3338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty