MEDICARE: OPHTHALMOLOGY CLINIC 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

General Provider Information

NPI Number	:	1700179934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPHTHALMOLOGY CLINIC INC

Provider Business Mailing Address
First Line	:	2595 HICKORY LN
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44124-4211
Country	:	US
Telephone Number	:	440-473-0930
Fax Number	:

Provider Business Practice Location Address
First Line	:	2595 HICKORY LN
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44124-4211
Country	:	US
Telephone Number	:	440-473-0930
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SAROJ D AGGARWAL
Credential	:	MD
Telephone Number	:	440-473-0930

Provider Enumeration Date	:	05/20/2011
Last Update Date	:	05/20/2011

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