Provider Demographics
NPI:1689623217
Name:JEMIOLA, CYNTHIA JULIA (OD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:JULIA
Last Name:JEMIOLA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PUBLIC SQ
Mailing Address - Street 2:SUITE 219
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-2316
Mailing Address - Country:US
Mailing Address - Phone:216-621-2815
Mailing Address - Fax:216-621-1745
Practice Address - Street 1:200 PUBLIC SQ
Practice Address - Street 2:SUITE 219
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2316
Practice Address - Country:US
Practice Address - Phone:216-621-2815
Practice Address - Fax:216-621-1745
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3452-T830152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0481572Medicaid
OHT47633Medicare UPIN
OH0481572Medicaid