Provider Demographics
NPI:1649481177
Name:WESTERN RESERVE OPHTHALMOLOGY INC
Entity type:Organization
Organization Name:WESTERN RESERVE OPHTHALMOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-514-1864
Mailing Address - Street 1:23250 CHAGRIN BLVD STE 440
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5445
Mailing Address - Country:US
Mailing Address - Phone:216-514-1864
Mailing Address - Fax:216-514-1867
Practice Address - Street 1:23250 CHAGRIN BLVD
Practice Address - Street 2:SUITE 440
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5470
Practice Address - Country:US
Practice Address - Phone:216-514-1864
Practice Address - Fax:216-514-1867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCN0841OtherMEDICARE RAILROAD
OH000000167534OtherANTHEM BC BS
OHDA9250771OtherMEDICARE DMERK
OH0889605Medicaid
OHDA9250771OtherMEDICARE DMERK
OH9250771Medicare ID - Type Unspecified