MEDICARE: MARYMOUNT OPTICAL

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	156FX1800X	Optician

General Provider Information

NPI Number	:	1326396060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYMOUNT OPTICAL

Provider Business Mailing Address
First Line	:	12000 MCCRACKEN RD STE 101
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-2933
Country	:	US
Telephone Number	:	216-581-0470
Fax Number	:	216-581-0474

Provider Business Practice Location Address
First Line	:	12000 MCCRACKEN RD STE 101
Second Line	:
City	:	GARFIELD HTS
State	:	OH
Zip	:	44125-2933
Country	:	US
Telephone Number	:	216-581-0470
Fax Number	:	216-581-0474

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. ILDIKO KONDRAY
Credential	:	M.D.
Telephone Number	:	216-581-0470

Provider Enumeration Date	:	08/28/2012
Last Update Date	:	08/28/2012

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Directions to “MARYMOUNT OPTICAL ” Practice Location

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