MEDICARE: THE CLEVELAND CLINIC FOUNDATION

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		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	:	1649441783
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE CLEVELAND CLINIC FOUNDATION

Provider Business Mailing Address
First Line	:	6801 BRECKSVILLE RD
Second Line	:	STE 20, ATTN:DPC RK2-7
City	:	INDEPENDENCE
State	:	OH
Zip	:	44131-5062
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	637 N UNION ST
Second Line	:
City	:	LOUDONVILLE
State	:	OH
Zip	:	44842-1074
Country	:	US
Telephone Number	:	419-994-4287
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE VP CHIEF FINANCE OFFICER
Name	:	DENNIS LARAWAY
Credential	:
Telephone Number	:	216-445-1343

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	08/20/2025

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Directions to “THE CLEVELAND CLINIC FOUNDATION ” Practice Location

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