MEDICARE: SHEFFIELD LAKE VISION CENTER 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	332B00000X	Durable Medical Equipment & Medical Supplies	3285T416	OH

General Provider Information

NPI Number	:	1659563583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHEFFIELD LAKE VISION CENTER INC

Provider Business Mailing Address
First Line	:	4282 E LAKE RD
Second Line	:
City	:	SHEFFIELD LAKE
State	:	OH
Zip	:	44054-1248
Country	:	US
Telephone Number	:	440-949-2204
Fax Number	:	440-949-4267

Provider Business Practice Location Address
First Line	:	4282 E LAKE RD
Second Line	:
City	:	SHEFFIELD LAKE
State	:	OH
Zip	:	44054-1248
Country	:	US
Telephone Number	:	440-949-2204
Fax Number	:	440-949-4267

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. GREGORY N DZIAMA
Credential	:	O.D.
Telephone Number	:	440-949-2204

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	02/09/2012

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