MEDICARE: CLEVELAND EYE CARE & SURGERY, 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	207W00000X	Ophthalmology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000725689	OTHER		ANTHEM BLUE CROSS AND BLUE SHIELD

General Provider Information

NPI Number	:	1558651968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND EYE CARE & SURGERY, INC.

Provider Business Mailing Address
First Line	:	24755 CHAGRIN BLVD
Second Line	:	SUITE 345
City	:	BEACHWOOD
State	:	OH
Zip	:	44122-5682
Country	:	US
Telephone Number	:	216-297-3230
Fax Number	:	216-342-5290

Provider Business Practice Location Address
First Line	:	36100 EUCLID AVE
Second Line	:	SUITE 450
City	:	WILLOUGHBY
State	:	OH
Zip	:	44094-4456
Country	:	US
Telephone Number	:	216-297-3230
Fax Number	:	216-291-4849

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID J MITCHELL
Credential	:	M.D,
Telephone Number	:	216-297-3230

Provider Enumeration Date	:	04/19/2011
Last Update Date	:	01/23/2014

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Directions to “CLEVELAND EYE CARE & SURGERY, INC. ” Practice Location

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