Provider Demographics
NPI:1649333659
Name:BERRIS OPTICAL OF SOLON
Entity type:Organization
Organization Name:BERRIS OPTICAL OF SOLON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MULCAHY
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:440-349-2225
Mailing Address - Street 1:33532 AURORA RD
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3706
Mailing Address - Country:US
Mailing Address - Phone:440-349-2225
Mailing Address - Fax:440-349-1226
Practice Address - Street 1:33532 AURORA RD
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-3706
Practice Address - Country:US
Practice Address - Phone:440-349-2225
Practice Address - Fax:440-349-1226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH18427920332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0443050001Medicare ID - Type Unspecified