Provider Demographics
NPI:1750565008
Name:FOR YOUR EYES ONLY, INC
Entity type:Organization
Organization Name:FOR YOUR EYES ONLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:440-585-2020
Mailing Address - Street 1:5900 SOM CENTER RD STE 19
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-3044
Mailing Address - Country:US
Mailing Address - Phone:440-585-2020
Mailing Address - Fax:
Practice Address - Street 1:5900 SOM CENTER RD STE 19
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-3044
Practice Address - Country:US
Practice Address - Phone:440-585-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2663152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0197700001Medicare NSC
OH9284252Medicare PIN