MEDICARE: STEPHEN F SASALA OD & ASSOC 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	40406	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295054856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN F SASALA OD & ASSOC INC

Provider Business Mailing Address
First Line	:	800 HURON RD E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-1121
Country	:	US
Telephone Number	:	216-781-7900
Fax Number	:	216-781-0554

Provider Business Practice Location Address
First Line	:	800 HURON RD E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-1121
Country	:	US
Telephone Number	:	216-781-7900
Fax Number	:	216-781-0554

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN FREDERICK SASALA
Credential	:	OD
Telephone Number	:	216-781-7900

Provider Enumeration Date	:	05/21/2010
Last Update Date	:	05/27/2010

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