Provider Demographics
NPI:1821000753
Name:WESTERN RESERVE EYE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:WESTERN RESERVE EYE ASSOCIATES, INC.
Other - Org Name:CLEARVISION CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:R
Authorized Official - Last Name:KERNIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-422-2020
Mailing Address - Street 1:1155 STATE ROUTE 303
Mailing Address - Street 2:
Mailing Address - City:STREETSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:44241-3969
Mailing Address - Country:US
Mailing Address - Phone:330-422-2020
Mailing Address - Fax:330-422-0316
Practice Address - Street 1:1155 STATE ROUTE 303
Practice Address - Street 2:
Practice Address - City:STREETSBORO
Practice Address - State:OH
Practice Address - Zip Code:44241-3969
Practice Address - Country:US
Practice Address - Phone:330-422-2020
Practice Address - Fax:330-422-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHT1453152W00000X
OHOH35046927R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2188912Medicaid
OH2188912Medicaid
OH9309071Medicare PIN