Healthcare Provider Details

I. General information

NPI: 1841528049
Provider Name (Legal Business Name): HANI F SADDIC ABOC/ NCLEC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2009
Last Update Date: 11/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 NORTHFIELD RD STE 6
BEDFORD HTS OH
44146-1135
US

IV. Provider business mailing address

5311 NORTHFIELD RD STE 6
BEDFORD HTS OH
44146-1135
US

V. Phone/Fax

Practice location:
  • Phone: 216-662-1160
  • Fax: 216-662-1161
Mailing address:
  • Phone: 216-662-1160
  • Fax: 216-662-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number6292SC
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number6292SC
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: