Provider Demographics
NPI:1750600151
Name:TEKNIPP EYECARE
Entity type:Organization
Organization Name:TEKNIPP EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:TEKNIPP
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:440-347-0696
Mailing Address - Street 1:30021 VINE ST.
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-3572
Mailing Address - Country:US
Mailing Address - Phone:440-347-0696
Mailing Address - Fax:440-944-0881
Practice Address - Street 1:30021 VINE ST.
Practice Address - Street 2:
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095-3572
Practice Address - Country:US
Practice Address - Phone:440-347-0696
Practice Address - Fax:440-944-0881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH-3414332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier