Provider Demographics
NPI:1952532905
Name:CYNTHIA J. JEMIOLA, O.D., INC.
Entity type:Organization
Organization Name:CYNTHIA J. JEMIOLA, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JULIA
Authorized Official - Last Name:JEMIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:216-621-2815
Mailing Address - Street 1:200 PUBLIC SQ
Mailing Address - Street 2:SUITE # 219
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-2316
Mailing Address - Country:US
Mailing Address - Phone:216-621-2815
Mailing Address - Fax:216-621-1745
Practice Address - Street 1:200 PUBLIC SQ
Practice Address - Street 2:SUITE # 219
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44114-2316
Practice Address - Country:US
Practice Address - Phone:216-621-2815
Practice Address - Fax:216-621-1745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-06
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3452-T830332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0481572Medicaid
T47633Medicare UPIN
0518743Medicare PIN
OH0481572Medicaid