Provider Demographics
NPI:1700068608
Name:PETER E SFORZA JR OD INC
Entity Type:Organization
Organization Name:PETER E SFORZA JR OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:SFORZA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-545-3000
Mailing Address - Street 1:514 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-1745
Mailing Address - Country:US
Mailing Address - Phone:330-545-3000
Mailing Address - Fax:330-545-5390
Practice Address - Street 1:514 N STATE ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:OH
Practice Address - Zip Code:44420-1745
Practice Address - Country:US
Practice Address - Phone:330-545-3000
Practice Address - Fax:330-545-5390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3968T1103152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0718763Medicaid
OH1002650001Medicare NSC
OH9272081Medicare PIN