Provider Demographics
NPI:1396716734
Name:GEORGE E. ATANASOFF, OD, INC.
Entity type:Organization
Organization Name:GEORGE E. ATANASOFF, OD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:ATANASOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-666-6786
Mailing Address - Street 1:1000 GHENT RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333
Mailing Address - Country:US
Mailing Address - Phone:330-666-6786
Mailing Address - Fax:330-666-6851
Practice Address - Street 1:1000 GHENT RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333
Practice Address - Country:US
Practice Address - Phone:330-666-6786
Practice Address - Fax:330-666-6851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4264T023152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0820960001OtherDMERC
OH0459150Medicaid
0820960001OtherDMERC
AT0706131Medicare ID - Type Unspecified