Provider Demographics
NPI:1720337975
Name:OPTICAL CREATIONS BY MEA LLC
Entity Type:Organization
Organization Name:OPTICAL CREATIONS BY MEA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMROVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-888-2333
Mailing Address - Street 1:7003 PEARL RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-4941
Mailing Address - Country:US
Mailing Address - Phone:440-888-2333
Mailing Address - Fax:440-888-2335
Practice Address - Street 1:7003 PEARL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-4941
Practice Address - Country:US
Practice Address - Phone:440-888-2333
Practice Address - Fax:440-888-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-04
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6779110001Medicare NSC