Provider Demographics
NPI:1831125483
Name:DOCTORS OF OPTOMETRY, INC.
Entity Type:Organization
Organization Name:DOCTORS OF OPTOMETRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P.
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZANOUDAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-885-0822
Mailing Address - Street 1:7448 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-6605
Mailing Address - Country:US
Mailing Address - Phone:440-885-0822
Mailing Address - Fax:440-885-7225
Practice Address - Street 1:7448 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-6605
Practice Address - Country:US
Practice Address - Phone:440-885-0822
Practice Address - Fax:440-885-7225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2792750Medicaid
OH2792750Medicaid
9264321Medicare PIN