Provider Demographics
NPI:1265692586
Name:EYEZONE
Entity type:Organization
Organization Name:EYEZONE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DMITRIY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHVETS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:440-684-0800
Mailing Address - Street 1:5852 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2903
Mailing Address - Country:US
Mailing Address - Phone:440-684-0800
Mailing Address - Fax:440-684-9066
Practice Address - Street 1:5852 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-2903
Practice Address - Country:US
Practice Address - Phone:440-684-0800
Practice Address - Fax:440-684-9066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18-485137332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2347197Medicaid