Provider Demographics
NPI:1700063070
Name:ADVANCED EYE CARE CENTERS OF CLEVELAND, INC.
Entity Type:Organization
Organization Name:ADVANCED EYE CARE CENTERS OF CLEVELAND, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:F
Authorized Official - Last Name:ASSEFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-520-2045
Mailing Address - Street 1:6595 BRECKSVILLE RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:INDEPENDENCE
Mailing Address - State:OH
Mailing Address - Zip Code:44131-4845
Mailing Address - Country:US
Mailing Address - Phone:216-520-2045
Mailing Address - Fax:216-520-4436
Practice Address - Street 1:6595 BRECKSVILLE RD
Practice Address - Street 2:SUITE 2
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-4845
Practice Address - Country:US
Practice Address - Phone:216-520-2045
Practice Address - Fax:216-520-4436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-02-9197A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1272910001Medicare NSC