Provider Demographics
NPI:1760554992
Name:SURGICAL SUCCESS
Entity Type:Organization
Organization Name:SURGICAL SUCCESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:I
Authorized Official - Last Name:PELTAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-871-2324
Mailing Address - Street 1:28743 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-2131
Mailing Address - Country:US
Mailing Address - Phone:440-871-2324
Mailing Address - Fax:440-871-2324
Practice Address - Street 1:28743 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-2131
Practice Address - Country:US
Practice Address - Phone:440-871-2324
Practice Address - Fax:440-871-2324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty