Healthcare Provider Details

I. General information

NPI: 1205855236
Provider Name (Legal Business Name): SUMMIT OPHTHALMOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PARK WEST BLVD SUITE 150
AKRON OH
44320
US

IV. Provider business mailing address

1 PARK WEST BLVD SUITE 150
AKRON OH
44320
US

V. Phone/Fax

Practice location:
  • Phone: 330-864-8060
  • Fax: 330-864-8191
Mailing address:
  • Phone: 330-864-8060
  • Fax: 330-864-8191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD R ELLISON
Title or Position: PRESIDENT
Credential: MD
Phone: 330-864-8060