Healthcare Provider Details

I. General information

NPI: 1760554992
Provider Name (Legal Business Name): SURGICAL SUCCESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28743 LINCOLN RD
BAY VILLAGE OH
44140-2131
US

IV. Provider business mailing address

28743 LINCOLN RD
BAY VILLAGE OH
44140-2131
US

V. Phone/Fax

Practice location:
  • Phone: 440-871-2324
  • Fax: 440-871-2324
Mailing address:
  • Phone: 440-871-2324
  • Fax: 440-871-2324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA I PELTAN
Title or Position: OFFICE MANAGER CFO
Credential:
Phone: 440-871-2324