MEDICARE: STANICH EYE CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4493	OH

General Provider Information

NPI Number	:	1023495546
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANICH EYE CARE, INC

Provider Business Mailing Address
First Line	:	660 RED ROCK DR
Second Line	:
City	:	WADSWORTH
State	:	OH
Zip	:	44281-2284
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	796 HOWE AVE
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-5124
Country	:	US
Telephone Number	:	330-928-3300
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHARON CHIRUMBOLE
Credential	:
Telephone Number	:	330-606-7890

Provider Enumeration Date	:	05/05/2015
Last Update Date	:	05/05/2015

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