Provider Demographics
NPI:1891192019
Name:CLEVELAND EYECARE, OD, PA
Entity Type:Organization
Organization Name:CLEVELAND EYECARE, OD, PA
Other - Org Name:CLEVELAND EYECARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-482-1234
Mailing Address - Street 1:422 W WARREN ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-5330
Mailing Address - Country:US
Mailing Address - Phone:704-482-1234
Mailing Address - Fax:704-482-3777
Practice Address - Street 1:422 W WARREN ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-5330
Practice Address - Country:US
Practice Address - Phone:704-482-1234
Practice Address - Fax:704-482-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1075152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty