Provider Demographics
NPI:1013285014
Name:CLEVELAND EYE CARE & SURGERY, INC.
Entity type:Organization
Organization Name:CLEVELAND EYE CARE & SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-297-3230
Mailing Address - Street 1:1611 SOUTH GREEN ROAD
Mailing Address - Street 2:SUITE 306D
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44121-4129
Mailing Address - Country:US
Mailing Address - Phone:216-297-3230
Mailing Address - Fax:216-291-4849
Practice Address - Street 1:122 SOUTHPARK CTR
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-9316
Practice Address - Country:US
Practice Address - Phone:440-572-4421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH006730Medicare PIN