Provider Demographics
NPI:1851419956
Name:ALESSIO OPTICAL
Entity Type:Organization
Organization Name:ALESSIO OPTICAL
Other - Org Name:PARK PLACE OPTICAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RENO
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALESSIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-238-5030
Mailing Address - Street 1:17534 ROYALTON ROAD
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-5151
Mailing Address - Country:US
Mailing Address - Phone:440-238-1515
Mailing Address - Fax:440-238-0030
Practice Address - Street 1:17534 ROYALTON ROAD
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-5151
Practice Address - Country:US
Practice Address - Phone:440-238-1515
Practice Address - Fax:440-238-0030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALESSIO EYE MD, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-27
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH47905156F00000X
OH35085164207W00000X
OH18-373349332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0665720001Medicare ID - Type Unspecified