Provider Demographics
NPI:1801842117
Name:DR. GEORGE D. POULOS & ASSOCIATES, INC.
Entity type:Organization
Organization Name:DR. GEORGE D. POULOS & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:POULOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:440-572-4421
Mailing Address - Street 1:122 SOUTHPARK CTR
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-9316
Mailing Address - Country:US
Mailing Address - Phone:440-572-4421
Mailing Address - Fax:
Practice Address - Street 1:122 SOUTHPARK CTR
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-9316
Practice Address - Country:US
Practice Address - Phone:440-572-4421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4581152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDR9362151Medicare PIN